Unanswered questions from Corticus and pragmatic suggestions 英文参考文献.docVIP

Available online /content/12/4/426 Letter Unanswered questions from Corticus and pragmatic suggestions Wolfgang Bauer, Jonathan Ball and Mike Grounds General Intensive Care Unit, St George’s Hospital, London, SW17 0QT, UK Corresponding author: Jonathan Ball, jball@sgul.ac.uk Published: 14 August 2008 Critical Care 2008, 12:426 (doi:10.1186/cc6967) This article is online at /content/12/4/426 ? 2008 BioMed Central Ltd See related commentary by Vincent, /content/12/2/141 Professor Vincent, in an eloquent commentary in Critical Care, calls for a further trial into supraphysiological cortico- steroid therapy in vasopressor-resistant shock [1]. Together with editorials in several of the intensive care journals, he has pointed out many of the shortcomings in the Corticus trial [2]. We would like to add to this chorus by posing a further Table 1 Time to shock reversal data from the Corticus study [2] Median time to shock reversal (days) Corticotrophin responders Corticotrophin nonresponders All patients question to the authors and putting forward some suggestions. Regrettably, we are prohibited from addressing these directly due to the Letters policy of the journal in which the original paper was published. Control 5.8 2.8 6.0 3.9 5.8 3.3 Hydrocortisone Data from numerous sources suggest that the earlier shock is reversed, the better the outcome – be it mortality, morbidity, length of stay or other surrogate endpoints. In the Corticus study, the median time to shock reversal was 2 to 3 days shorter in the hydrocortisone group (see Table 1). Despite Patients with evidence of acute myocardial depression or chronic insufficiency should be considered separately. this, no outcome improvement was demonstrated. No Second, patients who, having been stable for ≥2 hours on a dose of vasopressor, develop increasing dose requirements (≥20% increase), are unresponsive to a volume