| Popis: |
Corticosteroids, mainly produced by the adrenal glands, regulate the response to acute and chronic stress. Acute inflammation associated with critical illness may counteract the hypothalamic-pituitary-adrenal response, resulting in a condition called critical illness–related corticosteroid insufficiency. This condition may benefit from corticosteroid replacement. As it translates into a broad variety of clinical and biological syndromes, although there is still no gold standard, critical illness–related corticosteroid insufficiency may be best recognized by a blunted cortisol response to 250 µg of corticotropin given as an intravenous bolus. Corticosteroid replacement should rely on prolonged treatment with low to moderate doses. In practice, the type and duration of corticosteroid dose may vary with the cause of critical illness (e.g., sepsis, acute respiratory distress syndrome, trauma). Finally, optimal corticosteroid replacement should also include minimization of the risk of serious adverse events mainly by careful prevention of superinfection and avoidance of drugs that may potentiate corticosteroids’ deleterious effects on body metabolism or the nervous system. Key words: Adrenals – hypothalamic pituitary adrenal axis – sepsis – inflammation – cytokines – hydrocortisone |
