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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: Pro-Con Debate: Steroid use in ACTH non-responsive septic shock patients with high baseline cortisol levels. | Available online http ccforum.eom content 10 2 210 Review Pro-Con Debate Steroid use in ACTH non-responsive septic shock patients with high baseline cortisol levels Djillali Annane Eddy Fan2 and Margaret S Herridge2 3 Service de Réanimation Hôpital Raymond Poincaré AP-HP Université de Versailles SQ Garches France interdepartmental Division of Critical Care Medicine University of Toronto Toronto Canada 3Department of Medicine University of Toronto Toronto Canada Corresponding author Djillali Annane djillali.annane@npc.aphp.fr Published 5 April 2006 This article is online at http ccforum.com content 10 2 210 2006 BioMed Central Ltd Critical Care 2006 10 210 doi 10.1186 cc4856 Abstract Steroid use in critically ill vasopressor-dependant septic patients has gained increased acceptance in recent years with the publication of encouraging data. However with renewed interest and or attention comes increased debate and analysis. As a result it is not surprising to find that there is still significant controversy with regards to the role of steroids in many patients. In this article two expert groups debate the role of steroid use in a septic shock patient with arguably no clear evidence of adrenal insufficiency. The scenario A 57-year-old female has been admitted to the intensive care unit for 24 hours with septic shock. The patient requires significant amounts of noradrenaline norepinephrine . You decide to perform an adrenocorticotrophic hormone ACTH stimulation test the results of which show that the patient is a high nonresponder i.e. the baseline level is high and there is no increase after ACTH stimulation . You wonder about the benefit of administering steroids to reverse shock in this setting. Pro A blunted response to ACTH strongly suggests adrenal failure Djillali Annane Disruption of the hypothalamic-pituitary-adrenal HPA axis a major actor in the host response to stress occurs in about half of patients with vasopressor-dependent septic shock and is responsible .
