Stress doses of hydrocortisone reverse hyperdynamic septic shock

Briegel, Josef; Forst, H.; Haller, M.; Schelling, Gustav; Kilger, Erich; Kuprat, G.; Hemmer, B.; Hummel, Theresia; Lenhart, Andreas; Heyduck, Mathias; Scheffold, Christian; Peter, K.

doi:10.1097/00003246-199904000-00025

Cited by 791 publications

(112 citation statements)

References 45 publications

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“…We searched for references published in 2004 or later, when the standardized care for sepsis was introduced by SSCG 2004 after being defined in 1992 as a systemic inflammatory response syndrome (SIRS) accompanying infection, with the keywords “septic shock” and “low‐dose steroid,” and identified eight RCTs (Bollaert et al .,162 Briegel et al .,163 Chawla et al .,164 Annane et al .,165 Oppert et al .,166 Mussack et al .,167 Sprung et al .,156 and Arabi168). As these eight studies were all included in the meta‐analysis by Wang et al .,160 we initially decided to use it for this CQ.…”

Section: Cq8: Corticosteroid Therapy For Septic Shockmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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Background and PurposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two‐thirds (>66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J‐SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta‐analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese‐specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non‐specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

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Section: Cq8: Corticosteroid Therapy For Septic Shockmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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“…The benefit of hydrocortisone in patients with septic shock has been evaluated in 6 randomized control trials [34,45,48,49,50,51]. A meta-analysis of these trials demonstrates greater shock reversal on day 7 with hydrocortisone, but no benefit in terms of mortality [9].…”

Section: Managementmentioning

confidence: 99%

Critical Illness-Related Corticosteroid Insufficiency in Children

Levy‐Shraga

Pinhas‐Hamiel²

2013

Horm Res Paediatr

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Adequate adrenocortical function is essential for survival in critical illness. Most critically ill patients display elevated plasma cortisol concentrations, which reflects activation of the hypothalamic-pituitary-adrenal axis and is considered to be a homeostatic adaptation. However, many critically ill patients have ‘relative' or ‘functional' adrenal insufficiency, which is characterized by an inadequate production of cortisol in relation to an increased demand during periods of severe stress. Recently, the term ‘critical illness-related corticosteroid insufficiency' (CIRCI) was coined. CIRCI occurs as a result of a decrease in adrenal steroid production or tissue resistance to glucocorticoids. An international task force of the American College of Critical Care Medicine issued recommendations for the diagnosis and management of this condition in adult patients. We review the prevalence, diagnosis, and therapeutic approach to adrenal insufficiency in critically ill children. We found a lack of consensus within the pediatric field as to the optimal approach to CIRCI, and call for an international task force to establish unified guidelines.

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“…Recent work demonstrated that HE is the interplay between ammonia, inflammatory responses and autoregulation of cerebral hemodynamics [40]. 84 such cirrhotics were studied by Briegel et al [41]. The presence and severity of minimal HE were independent of severity of liver disease and ammonia concentration, but markers of inflammation were significantly higher in those with minimal HE compared with those without.…”

Section: Role Of Cytokines In Liver Complicationsmentioning

confidence: 99%

Role of Cytokines in the Pathophysiology of Acute-on-Chronic Liver Failure

Liu¹

2009

Blood Purif

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Background: This is the first ever decade which has witnessed the emergence of a highly lethal condition termed acute-on-chronic liver failure (ACLF), which today is the leading cause of death compared to acute and chronic liver failure. However, the complex pathophysiology of ACLF remains poorly understood. This article will attempt to summarize recent progress in the understanding of the mechanisms of cytokines in ACLF. Methods: The search terms used on PubMed were cytokines, liver injury, complications of liver disease, and hepatic progenitor cell. Results: Cytokines play a significant role in the pathophysiology of ACLF including hepatocellular death, extrahepatic complications and hepatocyte regeneration. The tissue-damaging mechanisms of cytokines are closely related to their hepatocyte proliferation and regeneration function. Conclusions: It remains a challenge to selectively prevent the detrimental effects of cytokines. To design interventions which selectively target the detrimental effects of cytokines, a detailed understanding of cytokines in the pathophysiology ACLF is critical.

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Stress doses of hydrocortisone reverse hyperdynamic septic shock

Cited by 791 publications

References 45 publications

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Critical Illness-Related Corticosteroid Insufficiency in Children

Role of Cytokines in the Pathophysiology of Acute-on-Chronic Liver Failure

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