全身炎癥反應(yīng)綜合癥與膿毒血癥下-wenkub
2022-08-15 17:36:53 本頁面
【正文】 day mortality: nonresponders p = placebo steroid survival 0 0 5 10 15 20 25 30 day 28 day mortality: responders septic shock 0 0 5 10 15 20 25 30 day placebo steroid Time to shock reversal: nonresponders septic shock 0 0 5 10 15 20 25 30 day placebo steroid Time to shock reversal: responders CORTICUS: Conclusions ? Hydrocortisone RX ? Did not decrease mortality ? Deceased time to shock reversal ? Was assoc. with an increased incidence of: ? Superinfections, including new episodes of sepsis or septic shock ? Hyperglycemia ? Hypernatremia Sprung C, et al. NEJM 20xx。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)。344:699709 0 7 14 21 28
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