全身炎癥反應(yīng)綜合癥與膿毒血癥（下）-文庫吧
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【正文】 CORTICUS Treatment start 8h of shock 72 h of shock Fludrocortisone Yes No Steroid taper No Yes More medical pts Yes No More surg pts No Yes More intraabd’l source of infxn No Yes Placebo mortality 61% 31% Nonresponders 77% 44% Clinical Practice Guidelines for the Diagnosis and Management of Corticosteroid Insufficiency in Critical Illness: Remendations from an International Task Force Marik PE, Pastores SM, Annane D, Meduri GU, Sprung C, et al. Crit Care Med (under review) Consensus Statement ? At this time, CIRCI is best diagnosed by a delta cortisol (following 250 181。g cosyntropin) of 9 181。g/dl or a random cortisol of 10 181。g/dl ? Free cortisol has advantages over total cortisol but not widely available ? The ACTH stim test should not be used to identify the subset of adult pts with septic shock who should receive hydrocortisone (2B) Marik PE, Pastores SM, Annane D, Meduri GU, Sprung C, et al. Crit Care Med 20xx (under review) Adrenal Task Force Consensus Panel Treatment and Duration ? Treatment regimens: ? 100 mg hydrocortisone IV q 8 h ? 100/200 mg bolus of hydrocortisone then 10 mg/h ? 50 mg hydrocortisone IV q 6 h ? Full dose hydrocortisone treatment should be continued for 57 days before tapering assuming there is no recurrence of signs of sepsis or shock (2C) Marik PE, Pastores SM, Annane D, Meduri GU, Sprung C, et al. Crit Care Med 20xx (under review) Consensus Statement ? Patients with septic shock should not receive dexamethasone if hydrocortisone is available (2B) ? Fludrocortisone is optional if hydrocortisone is used (2C) ? Doses of corticosteroids parable to 300 mg of hydrocortisone daily not be used in septic shock (1A) Marik PE, Pastores SM, Annane D, Meduri GU, Sprung C, et al. Crit Care Med 20xx (under review)。 SCC 20xx Update
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