Briegel Josef, Kilger Erich, Schelling Gustav
Department of Anaesthesiology, University Hospital, Ludwig-Maximilians University, Munich, Germany.
Curr Opin Crit Care. 2007 Aug;13(4):370-5. doi: 10.1097/MCC.0b013e3282435e2d.
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.
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.
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.
持续且严重的全身炎症影响危重症患者，可能导致肾上腺功能不全以及靶细胞的类固醇抵抗。由于对这一临床实体的准确诊断仍是一项挑战，危重症患者中皮质类固醇替代疗法的指征及实际应用通常由临床症状和体征来指导。
在过去两年中，已开展了一系列临床试验，以研究皮质类固醇替代疗法在患有各种原因引起的严重全身炎症的危重症患者中的应用。一些研究已证明发病率有所改善。近期研究的数据应会导致对危重症患者皮质类固醇替代疗法的限制。本综述的目的是在缺乏肾上腺功能不全的准确实验室评估的情况下，探讨危重症患者皮质类固醇替代疗法的指征及当前最佳实际应用。
皮质类固醇替代疗法可能会改善特定危重症患者目标群体的发病率和死亡率。合适的目标群体仍有待细化。为证明这一点，需要对危重症中的内分泌紊乱和皮质类固醇替代疗法进行更多研究。
