Josef Briegel1, Erich Kilger, Gustav Schelling. 1. Department of Anaesthesiology, University Hospital, Ludwig-Maximilians University, Munich, Germany. josef.briegel@med.uni-muenchen.de
Abstract
PURPOSE OF REVIEW: Ongoing and severe systemic inflammation affecting critically ill patients may cause adrenal insufficiency and steroid resistance in target cells. As the appropriate diagnosis of this clinical entity remains a challenge, indication and practical use of corticosteroid replacement therapy in the critically ill is generally directed by clinical symptoms and features. RECENT FINDINGS: In the last 2 years, a series of clinical trials have been undertaken to investigate corticosteroid replacement therapy in critically ill patients with severe systemic inflammation of various origin. Improvements of morbidity have been demonstrated in some studies. The data of recent studies should lead to a restriction of corticosteroid replacement therapy in critically ill patients. The purpose of this review is to investigate indications and the best current practical use of corticosteroid replacement therapy in critically ill patients in the absence of accurate laboratory assessment of adrenal insufficiency. SUMMARY: Corticosteroid replacement therapy may improve morbidity and mortality in specific target groups of critically ill patients. The appropriate target groups remain to be refined. To demonstrate this, additional studies are required on endocrine disorder in critical illness and corticosteroid replacement therapy.
PURPOSE OF REVIEW: Ongoing and severe systemic inflammation affecting critically illpatients may cause adrenal insufficiency and steroid resistance in target cells. As the appropriate diagnosis of this clinical entity remains a challenge, indication and practical use of corticosteroid replacement therapy in the critically ill is generally directed by clinical symptoms and features. RECENT FINDINGS: In the last 2 years, a series of clinical trials have been undertaken to investigate corticosteroid replacement therapy in critically illpatients with severe systemic inflammation of various origin. Improvements of morbidity have been demonstrated in some studies. The data of recent studies should lead to a restriction of corticosteroid replacement therapy in critically illpatients. The purpose of this review is to investigate indications and the best current practical use of corticosteroid replacement therapy in critically illpatients in the absence of accurate laboratory assessment of adrenal insufficiency. SUMMARY: Corticosteroid replacement therapy may improve morbidity and mortality in specific target groups of critically illpatients. The appropriate target groups remain to be refined. To demonstrate this, additional studies are required on endocrine disorder in critical illness and corticosteroid replacement therapy.