PURPOSE: Little is known about how published evidence regarding use of steroids in septic shock has been incorporated into clinical practice. MATERIALS AND METHODS: All patients admitted to an intensive care unit at a single, tertiary-care, academic medical center from November 1, 2004, through February 28, 2005, were screened using the hospital's computerized pharmacy database to determine if they had received at least 1 qualifying medication: cosyntropin, fludrocortisone, hydrocortisone, or dopamine, epinephrine, or norepinephrine as a vasopressor infusion. RESULTS: Only 58% (95% confidence interval, 47%-69%) of the 81 patients who met criteria for vasopressor-dependent septic shock (VDSS) were evaluated for critical illness-related corticosteroid insufficiency. Forty-seven percent of the 81 patients who met the criteria for VDSS and 49% of the 47 patients who did not meet the criteria for VDSS were treated with corticosteroids. Nearly all (85%; 95% confidence interval, 72%-94%) patients who did not meet the criteria for VDSS received an adrenocorticotropic hormone test. CONCLUSIONS: Treatment and evaluation of critical illness-related corticosteroid insufficiency in critically ill patients at our institution are inconsistent. Many patients with VDSS do not receive either treatment or evaluation for critical illness-related corticosteroid insufficiency, and patients who do not meet the current criteria are being evaluated and/or treated for critical illness-related corticosteroid insufficiency. Copyright (c) 2010 Elsevier Inc. All rights reserved.
PURPOSE: Little is known about how published evidence regarding use of steroids in septic shock has been incorporated into clinical practice. MATERIALS AND METHODS: All patients admitted to an intensive care unit at a single, tertiary-care, academic medical center from November 1, 2004, through February 28, 2005, were screened using the hospital's computerized pharmacy database to determine if they had received at least 1 qualifying medication: cosyntropin, fludrocortisone, hydrocortisone, or dopamine, epinephrine, or norepinephrine as a vasopressor infusion. RESULTS: Only 58% (95% confidence interval, 47%-69%) of the 81 patients who met criteria for vasopressor-dependent septic shock (VDSS) were evaluated for critical illness-related corticosteroid insufficiency. Forty-seven percent of the 81 patients who met the criteria for VDSS and 49% of the 47 patients who did not meet the criteria for VDSS were treated with corticosteroids. Nearly all (85%; 95% confidence interval, 72%-94%) patients who did not meet the criteria for VDSS received an adrenocorticotropic hormone test. CONCLUSIONS: Treatment and evaluation of critical illness-related corticosteroid insufficiency in critically illpatients at our institution are inconsistent. Many patients with VDSS do not receive either treatment or evaluation for critical illness-related corticosteroid insufficiency, and patients who do not meet the current criteria are being evaluated and/or treated for critical illness-related corticosteroid insufficiency. Copyright (c) 2010 Elsevier Inc. All rights reserved.
Authors: Dale M Needham; Amy W Wozniak; Catherine L Hough; Peter E Morris; Victor D Dinglas; James C Jackson; Pedro A Mendez-Tellez; Carl Shanholtz; E Wesley Ely; Elizabeth Colantuoni; Ramona O Hopkins Journal: Am J Respir Crit Care Med Date: 2014-05-15 Impact factor: 21.405
Authors: Matthew P Schreiber; Elizabeth Colantuoni; Oscar J Bienvenu; Karin J Neufeld; Kuan-Fu Chen; Carl Shanholtz; Pedro A Mendez-Tellez; Dale M Needham Journal: Crit Care Med Date: 2014-06 Impact factor: 7.598