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: Unanswered questions from Corticus and pragmatic suggestions. | Available online http content 12 4 426 Letter Unanswered questions from Corticus and pragmatic suggestions Wolfgang Bauer Jonathan Ball and Mike Grounds General Intensive Care Unit St George s Hospital London SW17 0QT UK Corresponding author Jonathan Ball jball@ Published 14 August 2008 This article is online at http content 12 4 426 2008 BioMed Central Ltd Critical Care 2008 12 426 doi cc6967 See related commentary by Vincent http content 12 2 141 Professor Vincent in an eloquent commentary in Critical Care calls for a further trial into supraphysiological corticosteroid therapy in vasopressor-resistant shock 1 . Together with editorials in several of the intensive care journals he has pointed out many of the shortcomings in the Corticus trial 2 . We would like to add to this chorus by posing a further question to the authors and putting forward some suggestions. Regrettably we are prohibited from addressing these directly due to the Letters policy of the journal in which the original paper was published. Data from numerous sources suggest that the earlier shock is reversed the better the outcome - be it mortality morbidity length of stay or other surrogate endpoints. In the Corticus study the median time to shock reversal was 2 to 3 days shorter in the hydrocortisone group see Table 1 . Despite this no outcome improvement was demonstrated. No investigation or explanation of this apparent discrepancy has been forthcoming. Sequential Organ Failure Assessment scores were performed at the time of study enrolment but no serial Sequential Organ Failure Assessment score data are presented. If available these data would be intriguing. Following the publication of the Corticus data a consensus statement regarding the diagnosis and management of corticosteroid insufficiency in critically ill adult patients has been published 3 . Together with a detailed review by Dickstein and Saiegh 4 this statement suggests a working
