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adrenal insufficiency in critical patients critical care medicine

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https://www.readbyqxmd.com/read/26414641/a-survey-of-attitudes-and-practices-regarding-the-use-of-steroid-supplementation-in-pediatric-sepsis
#1
Amanda Carmean, James D Fortenberry, Courtney McCracken, Kiran B Hebbar
OBJECTIVE: Although corticosteroid (CS) supplementation for pediatric septic shock (PSS) is recommended by American College of Critical Care Medicine sepsis guidelines, most data are based on adult trials. Standardized protocols for stimulation testing for adrenal insufficiency (AI) and CS treatment in children have been reported, but the current state of CS use and protocols have not been evaluated in pediatric intensive care units in the United States. We surveyed a group of pediatric intensivists to assess current approaches...
October 2015: Pediatric Emergency Care
https://www.readbyqxmd.com/read/25516097/controversies-surrounding-critical-illness-related-corticosteroid-insufficiency-in-animals
#2
REVIEW
Jamie M Burkitt Creedon
OBJECTIVES: To describe the controversies surrounding critical illness-related corticosteroid insufficiency (CIRCI) and the use of hydrocortisone in critically ill patients, and to present published diagnostic and therapeutic strategies in companion veterinary species. ETIOLOGY: Critical illness-related corticosteroid insufficiency may be due to hypothalamic-pituitary-adrenal (HPA) axis dysfunction, alterations in cortisol-plasma protein binding, target cell enzymatic changes, changes in glucocorticoid receptor (GR) function, or a combination of these or other factors present during critical illness...
January 2015: Journal of Veterinary Emergency and Critical Care
https://www.readbyqxmd.com/read/24217117/critical-illness-related-corticosteroid-insufficiency-in-children
#3
REVIEW
Yael Levy-Shraga, Orit Pinhas-Hamiel
Adequate adrenocortical function is essential for survival in critical illness. Most critically ill patients display elevated plasma cortisol concentrations, which reflects activation of the hypothalamic-pituitary-adrenal axis and is considered to be a homeostatic adaptation. However, many critically ill patients have 'relative' or 'functional' adrenal insufficiency, which is characterized by an inadequate production of cortisol in relation to an increased demand during periods of severe stress. Recently, the term 'critical illness-related corticosteroid insufficiency' (CIRCI) was coined...
2013: Hormone Research in Pædiatrics
https://www.readbyqxmd.com/read/23606231/corticosteroid-use-in-the-intensive-care-unit-a-survey-of-intensivists
#4
MULTICENTER STUDY
François Lamontagne, Hector Quiroz Martinez, Neill K J Adhikari, Deborah J Cook, Karen K Y Koo, François Lauzier, Alexis F Turgeon, Michelle E Kho, Karen E A Burns, Clarence Chant, Rob Fowler, Ivor Douglas, Yannick Poulin, Karen Choong, Niall D Ferguson, Maureen O Meade
OBJECTIVE: The efficacy of systemic corticosteroids in many critical illnesses remains uncertain. Our primary objective was to survey intensivists in North America about their perceived use of corticosteroids in clinical practice. DESIGN: Self-administered paper survey. POPULATION: Intensivists in academic hospitals with clinical trial expertise in critical illness. MEASUREMENTS: We generated questionnaire items in focus groups and refined them after assessments of clinical sensibility and test-retest reliability and pilot testing...
July 2013: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/22341536/evidence-based-neonatal-pharmacotherapy-postnatal-corticosteroids
#5
REVIEW
Kristi Watterberg
Corticosteroids are used in the neonatal intensive care unit primarily to treat two conditions: bronchopulmonary dysplasia (BPD) and hypotension (cardiovascular insufficiency). Historically, high-dose dexamethasone was used for BPD, but its use was later associated with adverse neurodevelopmental outcomes and decreased substantially. Data from randomized controlled trials regarding efficacy and safety of lower-dose dexamethasone therapy are insufficient to recommend its use. Hydrocortisone may be an alternative to dexamethasone, but again data are insufficient to support use...
March 2012: Clinics in Perinatology
https://www.readbyqxmd.com/read/22269144/a-strategy-for-management-of-intraoperative-addisonian-crisis-during-coronary-artery-bypass-grafting
#6
Celma D'Silva, Dale Watson, Dumbor Ngaage
Patients with Addison's disease undergoing cardiac surgery are at risk of developing a crisis. There is no consensus on the preoperative and intraoperative management of this group of patients undergoing cardiac surgery so the recommendations for non-cardiac patients are often used. The consensus statement from the international task force of the American College of Critical Care medicine recommends 100 mg of intravenous hydrocortisone for patients with adrenal insufficiency in septic shock, but in patients undergoing surgery, especially with extracorporeal circulation, the dosage may even be higher...
April 2012: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/21726354/low-dose-hydrocortisone-treatment-for-patients-with-septic-shock-a-pilot-study-comparing-3days-with-7days
#7
RANDOMIZED CONTROLLED TRIAL
Jin Won Huh, Hye-Sook Choi, Chae-Man Lim, Younsuck Koh, Yeon Mok Oh, Tae Sun Shim, Sang D O Lee, Woo Sung Kim, Dong Soon Kim, Sang-Bum Hong
BACKGROUND AND OBJECTIVE: Although there is controversy regarding the benefit of low-dose corticosteroid therapy in patients with septic shock, the Surviving Sepsis Campaign has advocated that low-dose intravenous hydrocortisone be used to treat adult septic shock patients. This study investigated the effect of the duration of a stress dose of hydrocortisone on survival of septic shock patients with relative adrenal insufficiency. METHODS: One hundred and thirty consecutive patients who met the American College of Chest Physicians/Society of Critical Care Medicine criteria for septic shock were included in the study...
October 2011: Respirology: Official Journal of the Asian Pacific Society of Respirology
https://www.readbyqxmd.com/read/19911854/acute-severe-asthma-new-approaches-to-assessment-and-treatment
#8
Spyros A Papiris, Effrosyni D Manali, Likurgos Kolilekas, Christina Triantafillidou, Iraklis Tsangaris
The precise definition of a severe asthmatic exacerbation is an issue that presents difficulties. The term 'status asthmaticus' relates severity to outcome and has been used to define a severe asthmatic exacerbation that does not respond to and/or perilously delays the repetitive or continuous administration of short-acting inhaled beta(2)-adrenergic receptor agonists (SABA) in the emergency setting. However, a number of limitations exist concerning the quantification of unresponsiveness. Therefore, the term 'acute severe asthma' is widely used, relating severity mostly to a combination of the presenting signs and symptoms and the severity of the cardiorespiratory abnormalities observed, although it is well known that presentation does not foretell outcome...
2009: Drugs
https://www.readbyqxmd.com/read/19751024/current-controversies-in-critical-illness-related-corticosteroid-insufficiency-and-glucocorticoid-supplementation
#9
REVIEW
A Kendall Gross, P Shane Winstead
The stress response, which is triggered by a number of factors, including surgery, results in activation of the hypothalamic pituitary adrenal axis and subsequent release of cortisol from the adrenal glands. Critical illness-related corticosteroid insufficiency is an inadequate corticosteroid response relative to a patient's illness; patients with critical illness-related corticosteroid insufficiency have both insufficient circulating cortisol and impaired cellular use of glucocorticoids. Corticosteroids, such as hydrocortisone, have been cited to improve survival, oxygenation, duration of mechanical ventilation, and intensive care unit-free days in critically ill patients...
September 2009: Orthopedics
https://www.readbyqxmd.com/read/19325359/clinical-practice-parameters-for-hemodynamic-support-of-pediatric-and-neonatal-septic-shock-2007-update-from-the-american-college-of-critical-care-medicine
#10
Joe Brierley, Joseph A Carcillo, Karen Choong, Tim Cornell, Allan Decaen, Andreas Deymann, Allan Doctor, Alan Davis, John Duff, Marc-Andre Dugas, Alan Duncan, Barry Evans, Jonathan Feldman, Kathryn Felmet, Gene Fisher, Lorry Frankel, Howard Jeffries, Bruce Greenwald, Juan Gutierrez, Mark Hall, Yong Y Han, James Hanson, Jan Hazelzet, Lynn Hernan, Jane Kiff, Niranjan Kissoon, Alexander Kon, Jose Irazuzta, Jose Irazusta, John Lin, Angie Lorts, Michelle Mariscalco, Renuka Mehta, Simon Nadel, Trung Nguyen, Carol Nicholson, Mark Peters, Regina Okhuysen-Cawley, Tom Poulton, Monica Relves, Agustin Rodriguez, Ranna Rozenfeld, Eduardo Schnitzler, Tom Shanley, Saraswati Kache, Sara Skache, Peter Skippen, Adalberto Torres, Bettina von Dessauer, Jacki Weingarten, Timothy Yeh, Arno Zaritsky, Bonnie Stojadinovic, Jerry Zimmerman, Aaron Zuckerberg
BACKGROUND: The Institute of Medicine calls for the use of clinical guidelines and practice parameters to promote "best practices" and to improve patient outcomes. OBJECTIVE: 2007 update of the 2002 American College of Critical Care Medicine Clinical Guidelines for Hemodynamic Support of Neonates and Children with Septic Shock. PARTICIPANTS: Society of Critical Care Medicine members with special interest in neonatal and pediatric septic shock were identified from general solicitation at the Society of Critical Care Medicine Educational and Scientific Symposia (2001-2006)...
February 2009: Critical Care Medicine
https://www.readbyqxmd.com/read/19214457/-corticosteroid-insufficiency-in-the-critically-ill-pathomechanisms-and-recommendations-for-diagnosis-and-treatment
#11
REVIEW
J Briegel, M Vogeser, D Keh, P Marik
Critically ill patients with severe systemic inflammation can develop critical illness-related corticosteroid insufficiency (CIRCI), which is associated with a poor outcome. A task force of the American College of Critical Care Medicine compiled recommendations for diagnosis and treatment of this clinical entity thereby focusing on patients with septic shock and acute respiratory distress syndrome (ARDS). The results of large scale multi-centre trials gave partially conflicting results arguing against the broad use of corticosteroids in stress doses...
February 2009: Der Anaesthesist
https://www.readbyqxmd.com/read/19092649/cardiovascular-manifestations-of-sedatives-and-analgesics-in-the-critical-care-unit
#12
REVIEW
Jamil Darrouj, Lama Karma, Rohit Arora
There are numerous sedatives and analgesics used in critical care medicine today; these medications are used on critically ill patients, many of whom have heart disease, including coronary artery disease or congestive heart failure. The purpose of this review is to recognize the effects of these medications on the heart. Studies that evaluated the effects of sedatives and analgesics on normal individuals or on those with heart disease were reviewed. Current choices for sustained sedation in the critically ill include the benzodiazepines, morphine, propofol, and etomidate...
July 2009: American Journal of Therapeutics
https://www.readbyqxmd.com/read/18644822/is-steroid-therapy-ever-of-benefit-to-patients-in-the-intensive-care-unit-going-into-septic-shock
#13
REVIEW
Lydia Richardson, Steven Hunter
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, is steroid therapy ever of benefit to patients in the intensive care unit going into septic shock? Using the reported search 1505 papers were identified. Fourteen papers represented the best evidence on the subject. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study comments and weaknesses were tabulated. Recent guidelines from the Surviving Sepsis Campaign recommend using stress doses of corticosteroids for septic shock regardless of adrenal function...
October 2008: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/18499615/free-cortisol-in-sepsis-and-septic-shock
#14
MULTICENTER STUDY
Stepani Bendel, Sari Karlsson, Ville Pettilä, Pekka Loisa, Marjut Varpula, Esko Ruokonen
BACKGROUND: Severe sepsis activates the hypothalamopituitary axis, increasing cortisol production. In some studies, hydrocortisone substitution based on an adrenocorticotropic hormone-stimulation test or baseline cortisol measurement has improved outcome. Because only the free fraction of cortisol is active, measurement of free cortisol may be more important than total cortisol in critically ill patients. We measured total and free cortisol in patients with severe sepsis and related the concentrations to outcome...
June 2008: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/18496365/recommendations-for-the-diagnosis-and-management-of-corticosteroid-insufficiency-in-critically-ill-adult-patients-consensus-statements-from-an-international-task-force-by-the-american-college-of-critical-care-medicine
#15
Paul E Marik, Stephen M Pastores, Djillali Annane, G Umberto Meduri, Charles L Sprung, Wiebke Arlt, Didier Keh, Josef Briegel, Albertus Beishuizen, Ioanna Dimopoulou, Stylianos Tsagarakis, Mervyn Singer, George P Chrousos, Gary Zaloga, Faran Bokhari, Michael Vogeser
OBJECTIVE: To develop consensus statements for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients. PARTICIPANTS: A multidisciplinary, multispecialty task force of experts in critical care medicine was convened from the membership of the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. In addition, international experts in endocrinology were invited to participate. DESIGN/METHODS: The task force members reviewed published literature and provided expert opinion from which the consensus was derived...
June 2008: Critical Care Medicine
https://www.readbyqxmd.com/read/18158437/surviving-sepsis-campaign-international-guidelines-for-management-of-severe-sepsis-and-septic-shock-2008
#16
R Phillip Dellinger, Mitchell M Levy, Jean M Carlet, Julian Bion, Margaret M Parker, Roman Jaeschke, Konrad Reinhart, Derek C Angus, Christian Brun-Buisson, Richard Beale, Thierry Calandra, Jean-Francois Dhainaut, Herwig Gerlach, Maurene Harvey, John J Marini, John Marshall, Marco Ranieri, Graham Ramsay, Jonathan Sevransky, B Taylor Thompson, Sean Townsend, Jeffrey S Vender, Janice L Zimmerman, Jean-Louis Vincent
OBJECTIVE: To provide an update to the original Surviving Sepsis Campaign clinical management guidelines, "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," published in 2004. DESIGN: Modified Delphi method with a consensus conference of 55 international experts, several subsequent meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee...
January 2008: Critical Care Medicine
https://www.readbyqxmd.com/read/18058085/surviving-sepsis-campaign-international-guidelines-for-management-of-severe-sepsis-and-septic-shock-2008
#17
R Phillip Dellinger, Mitchell M Levy, Jean M Carlet, Julian Bion, Margaret M Parker, Roman Jaeschke, Konrad Reinhart, Derek C Angus, Christian Brun-Buisson, Richard Beale, Thierry Calandra, Jean-Francois Dhainaut, Herwig Gerlach, Maurene Harvey, John J Marini, John Marshall, Marco Ranieri, Graham Ramsay, Jonathan Sevransky, B Taylor Thompson, Sean Townsend, Jeffrey S Vender, Janice L Zimmerman, Jean-Louis Vincent
OBJECTIVE: To provide an update to the original Surviving Sepsis Campaign clinical management guidelines, "Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock," published in 2004. DESIGN: Modified Delphi method with a consensus conference of 55 international experts, several subsequent meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee...
January 2008: Intensive Care Medicine
https://www.readbyqxmd.com/read/17417118/identification-of-adrenal-insufficiency-in-pediatric-critical-illness
#18
Kusum Menon, Margaret Lawson
OBJECTIVE: To determine physicians' beliefs and practices regarding adrenal dysfunction in pediatric critical illness. DESIGN: Cross-sectional mail survey. SETTING: Canada. PARTICIPANTS: All members of the Canadian Pediatric Endocrine Group and all physicians identified as practicing pediatric intensive care medicine in any of 16 tertiary care teaching centers in Canada. INTERVENTIONS: Three pediatric intensive care physicians and three pediatric endocrinologists reviewed the questionnaire before administration to ensure clarity...
May 2007: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/15616387/the-immunoneuroendocrine-axis-in-critical-illness-beneficial-adaptation-or-neuroendocrine-exhaustion
#19
REVIEW
Albertus Beishuizen, Lambertus G Thijs
PURPOSE OF REVIEW: Over the last years, endocrinology has been incorporated in critical care medicine, and acknowledgment of the complex neuro-endocrine adaption of critical illness has led to new insights and major breakthroughs in clarifying pathophysiological mechanisms and the targeting of therapeutic strategies. This review focuses on the important role of the hypothalamic-pituitary-adrenal (HPA) axis during critical illness and the occurrence of neuroendocrine failure. RECENT FINDINGS: The distinction between acute (activated anterior pituitary function and inactivated peripheral anabolic pathways) and prolonged (reduced neuroendocrine stimulation) critical illness as different neuroendocrine paradigms has brought a new approach to the critically ill patient...
December 2004: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/12194394/an-evidence-based-review-on-the-use-of-corticosteroids-in-peri-operative-and-critical-care
#20
REVIEW
Yin-Yi Han, Wei-Zen Sun
With complex and extensive pharmacological effects, corticosteroids are widely used in many clinical situations. A survey conducted to define the role of corticosteroids in various settings of peri-operative and critical care gave strong evidence to support that the use of corticosteroid is absolutely indicated in patients with adrenal insufficiency, asthma, anaphylaxis, acute spinal cord injury, and increased ICP resulting from brain tumors. As the benefits of corticosteroids are much in evidence, their uses are recommended to extend to postoperative antiemesis, acute respiratory failure (such as ARDS, COPD, and fat embolism), increased ICP associated with brain abscess, thyroid storm, and refractory hypothermia...
June 2002: Acta Anaesthesiologica Sinica
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