Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: Cortisol replacement for severe sepsis and septic shock: what should I do? | Critical Care June 2002 Vol 6 No 3 Annane Commentary Cortisol replacement for severe sepsis and septic shock what should I do Djillali Annane Co-director Intensive Care Department Raymond Poincaré University Hospital Garches France Correspondence Djillali Annane Published online 9 May 2002 Critical Care 2002 6 190-191 2002 BioMed Central Ltd Print ISSN 1364-8535 Online ISSN 1466-609X Abstract Based on several recently completed randomized controlled trials cortisol replacement is likely to become a standard of care for vasopressor dependent septic shock. Further studies are needed in order to accomplish whether this treatment should be limited to patients with a blunted cortisol response to corticotrophin. Similarly in patients with severe sepsis who do not need vasopressors the benefit risk ratio of cortisol replacement remains to be assessed. Keywords ACTH test hydrocortisone sepsis shock survival In this issue of Critical Care Yildiz and colleagues reported the first randomized controlled trial on the efficacy and safety of physiologic doses of steroids in severe sepsis 1 . During the past 5 years five phase II trials and a phase III placebo-controlled trial on cortisol replacement . prolonged treatment with physiologic doses of steroids have been completed in patients with vasopressor-dependent septic shock Table 1 2-6 . Two of them have already been published in peer-reviewed journals 2 3 three have been published in abstract form and will be published shortly in peer reviewed journals 4-6 and the results of a phase II trial that has just been completed will be available very soon Oppert and colleagues personal communication . These trials have consistently shown beneficial effects of cortisol replacement on the amount of vasopressors 2-6 on the duration of shock 2-4 6 on the duration and intensity of organ dysfunction 3 6 and on the intensity of the systemic inflammatory response 5 6 . The survival benefit observed with
