tailieunhanh - Báo cáo khoa học: "Bolus or continuous hydrocortisone – that is the question"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Bolus or continuous hydrocortisone – that is the question. | Available online http content 11 1 113 Commentary Bolus or continuous hydrocortisone - that is the question Steffen Weber-Carstens and Didier Keh Clinic of Anesthesiology and Intensive Care Medicine Charité Universitatsmedizin Berlin Campus Virchow-Klinikum Campus Mitte Augustenburger Platz 13353 Berlin Germany Corresponding author Steffen Weber-Carstens Published 20 February 2007 This article is online at http content 11 1 113 2007 BioMed Central Ltd Critical Care 2007 11 113 doi cc5669 See related research by Loisa et al. http content 11 1 R21 Abstract Constantly evolving treatment guidelines based on a growing body of randomized controlled trials are helping us to improve outcomes in sepsis. However it must be borne in mind that proven benefit from individual sepsis treatments does not guarantee synergistic beneficial effects when new treatments are added to sepsis management. Indeed unexpected harmful interactions are also possible. A good example of this is the conflict between intensive insulin therapy and low dose hydrocortisone in septic shock. The goal of tight glycaemic control is made more complicated by steroid-induced hyperglycaemia. In their recent study Loisa and coworkers demonstrate a measure that reduces the risk for this interaction. They found continuous infusion of hydrocortisone to be associated with fewer hyperglycaemic episodes and reduced staff workload compared with bolus application. In this issue of Critical Care Loisa and coworkers 1 present the first randomized controlled trial on the influence of mode of hydrocortisone administration on glycaemic control in patients with septic shock. During the past few years intensive insulin therapy has come to be recognized as a key component of treatment of critically ill patients with significant impact on morbidity and mortality 2 . However it has also been shown that these findings are not necessarily applicable to .