A 3-Level Prognostic Classification in Septic Shock Based on Cortisol Levels and Cortisol Response to Corticotropin

Annane, Djillali; Sébille, Véronique; Troché, Gilles; Raphaël, Jean Claude; Gajdos, Philippe; Bellissant, Éric

doi:10.1001/jama.283.8.1038

Cited by 919 publications

(728 citation statements)

References 42 publications

(54 reference statements)

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“…22 Children who die from MD have lower baseline cortisol levels compared with children who survive. 23 Children who die of MD also present with higher ACTH levels (i.e., lower cortisol:ACTH ratio), which denotes an inappropriate cortisol production.…”

Section: Use Of Steroidsmentioning

confidence: 99%

Doença meningocócica e meningite

Branco

Amoretti

Tasker

2007

J. Pediatr. (Rio J.)

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Objective: To review the literature relevant to diagnosis and management of meningococcal disease (MD).Sources: Non-systematic review of medical literature through the MEDLINE database using the terms meningococcal, septic shock, diagnosis, and treatment. Articles were selected according to their relevance to the objective of the study and according to the authors' opinion. Summary of the findings:MD is a leading cause of death due to infection in children. It progresses rapidly and a high level of suspicion is necessary for early diagnosis. Early intervention with aggressive fluid resuscitation and

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Section: Use Of Steroidsmentioning

confidence: 99%

Doença meningocócica e meningite

Branco

Amoretti

Tasker

2007

J. Pediatr. (Rio J.)

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“…59 In critically ill patients in septic shock, the use of corticosteroids has improved survival in those patients with relative adrenal insufficiency. 83,84 However, it is uncertain whether the beneficial effect of corticosteroids in cadaveric donors is a result of hormonal replacement or a modulatory effect of the inflammatory process described after the NDD. 21,[85][86][87][88] A recent consensus has recommended that donors with a left ventricular ejection fraction of less than 45% after standard management be treated with a combination of methylprednisolone, T3, and vasopressin.…”

Section: Temporal Considerationsmentioning

confidence: 99%

Medical management to optimize donor organ potential: review of the literature

Kutsogiannis

Pagliarello

Doig

et al. 2006

Can J Anesth/J Can Anesth

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Purpose: Over the past two decades, the demand for donor organs continues to outpace the number of organs available for transplantation. Parallel with this has been a change in the demographics of organ donors with an increase in older donors and donors with marginal organs as a proportion of the total organ donor pool. Consequently, efforts have been made to improve the medical care delivered to potential organ donors to improve the conversion rate and graft survival of available organs. The purpose of this literature review is to provide updated recommendations for the contemporary management of organ donors after the neurological determination of death in order to maximize the probability of recipient graft survival. Sources:A comprehensive review of the literature obtained through searches of MEDLINE/PubMed, and personal reference files.Principal findings: Contemporary management of the organ donor after neurological determination of death includes therapies to prevent the detrimental effects of the autonomic storm, the use of invasive hemodynamic monitoring and aggressive respiratory therapy including therapeutic bronchoscopy in marginal heart and lung donors, and the use of hormonal therapy including vasopressin, corticosteroids, triiodothyronine or thyroxine, and insulin for the pituitary failure and inflammation seen in brain dead organ donors. The importance of normalizing donor physiology to optimize all available organs is stressed. Conclusion:Aggressive hemodynamic and respiratory management of solid organ donors, coupled with the use of hormonal therapy improves the rate of conversion and graft survival in solid organ recipients. Objectif

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“…Several clinical studies published recently [4][5][6] have suggested potential benefit to early corticosteroids, with or without mineralocorticoids, for hemodynamically unstable septic patients, with or without relative or absolute adrenal insufficiency. A French multicentre randomized trial of exogenous glucocorticoid and mineralocorticoid treatment is currently undergoing peer review; it suggests a beneficial effect on mortality with early treatment.…”

Section: Corticosteroidsmentioning

confidence: 99%