Abstract:
OBJECTIVE:Cortisol clearance is reduced in sepsis and may contribute to the development of impaired adrenocortical function that is thought to contribute to the pathophysiology of critical illness-related corticosteroid insufficiency. We sought to assess adrenocortical function using computer-assisted numerical modeling methodology to characterize and compare maximal cortisol secretion rate and free cortisol half-life in septic shock, sepsis, and healthy control subjects. DESIGN:Post hoc analysis of previously published total cortisol, free cortisol, corticosteroid-binding globulin, and albumin concentration data. SETTING:Single academic medical center. PATIENTS:Subjects included septic shock (n = 45), sepsis (n = 25), and healthy controls (n = 10). INTERVENTIONS:I.v. cosyntropin (250 μg). MEASUREMENTS AND MAIN RESULTS:Solutions for maximal cortisol secretion rate and free cortisol half-life were obtained by least squares solution of simultaneous, nonlinear differential equations that account for free cortisol appearance and elimination as well as reversible binding to corticosteroid-binding globulin and albumin. Maximal cortisol secretion rate was significantly greater in septic shock (0.83 nM/s [0.44, 1.58 nM/s] reported as median [lower quartile, upper quartile]) compared with sepsis (0.51 nM/s [0.36, 0.62 nM/s]; p = 0.007) and controls (0.49 nM/s [0.42, 0.62 nM/s]; p = 0.04). The variance of maximal cortisol secretion rate in septic shock was also greater than that of sepsis or control groups (F test, p < 0.001). Free cortisol half-life was significantly increased in septic shock (4.6 min [2.2, 6.3 min]) and sepsis (3.0 min [2.3, 4.8 min] when compared with controls (2.0 min [1.2, 2.6 min]) (both p < 0.004). CONCLUSIONS:Results obtained by numerical modeling are consistent with comparable measures obtained by the gold standard stable isotope dilution method. Septic shock is associated with generally not only higher levels but also greater variance of maximal cortisol secretion rate when compared with control and sepsis groups. Additional studies would be needed to determine whether assessment of cortisol kinetic parameters such as maximal cortisol secretion rate and free cortisol half-life is useful in the diagnosis or management of critical illness-related corticosteroid insufficiency.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Dorin RI,Qualls CR,Torpy DJ,Schrader RM,Urban FK 3rddoi
10.1097/CCM.0000000000000721subject
Has Abstractpub_date
2015-03-01 00:00:00pages
549-56issue
3eissn
0090-3493issn
1530-0293journal_volume
43pub_type
杂志文章abstract:OBJECTIVES:Hospitals use a variety of strategies to maximize the availability of limited ICU beds. Boarding, which involves assigning patients to an open bed in a different subspecialty ICU, is one such practice employed when ICU occupancy levels are high, and beds in a particular unit are unavailable. Boarding disrupt...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002905
更新日期:2018-04-01 00:00:00
abstract:BACKGROUND:Although thrombocytopenia in the intensive care unit (ICU) is associated with a poorer outcome, the precise relationship between the time course of platelet counts and the mortality rate has not been well defined. OBJECTIVE:To describe the time course of the platelet count in relation to the mortality rate ...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/00003246-200204000-00005
更新日期:2002-04-01 00:00:00
abstract:OBJECTIVES:To examine the effect of extracorporeal membrane oxygenation (ECMO) therapy on platelet function and number and to determine the in vivo survival of transfused platelets during ECMO. DESIGN:Prospective study of all neonates treated with ECMO during a 6-month period. SETTING:Neonatal intensive care unit in ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199307000-00018
更新日期:1993-07-01 00:00:00
abstract:OBJECTIVE:To examine the effects of hypertonic (7.5%) saline-6% dextran 70 (HSD) and isotonic (0.9%) saline-6% dextran 70 (ISD) on cardiovascular function and intestinal perfusion in experimental endotoxin shock. DESIGN:Experimental, randomized, unblinded, interventional study. SETTING:University experimental animal ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200008000-00027
更新日期:2000-08-01 00:00:00
abstract:OBJECTIVES:A growing number of patients survive sepsis hospitalizations each year and are at high risk for readmission. However, little is known about temporal trends in hospital-based acute care (emergency department treat-and-release visits and hospital readmission) after sepsis. Our primary objective was to measure ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002872
更新日期:2018-03-01 00:00:00
abstract:BACKGROUND AND METHODS:We postulated that low-dose heparin (10 IU/kg.hr) administered as a continuous iv infusion may prevent or ameliorate the induction of thrombin-induced disseminated intravascular coagulation in baboons under general anesthesia. In a nonrandomized experiment lasting 8 hrs, animals were divided into...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199109000-00017
更新日期:1991-09-01 00:00:00
abstract:OBJECTIVE:To review trial design issues related to control groups. DESIGN:Review of the literature with specific reference to critical care trials. MAIN RESULTS AND CONCLUSIONS:Performing randomized controlled trials in the critical care setting presents specific problems: studies include patients with rapidly lethal...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181922bf4
更新日期:2009-01-01 00:00:00
abstract:OBJECTIVE:When treating patients with cardiac arrest with mild therapeutic hypothermia, a reliable and easy-to-use temperature probe is desirable. This study was conducted to investigate the accuracy and safety of tracheal temperature as a measurement of body temperature. DESIGN:Observational cohort study. SETTING:Em...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181e47a20
更新日期:2010-07-01 00:00:00
abstract:OBJECTIVE:To assess the mortality rate and complications in a population of surgical patients with severe adult respiratory distress syndrome (ARDS) treated with positive end-expiratory pressure (PEEP) of > 15 cm H2O in an attempt to reduce intrapulmonary shunt to approximately 0.20 and reduce FIO2 to < 0.50. DESIGN:R...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199509000-00008
更新日期:1995-09-01 00:00:00
abstract:OBJECTIVES:With the exception of a few single-center descriptive reports, data on critical care organizations are relatively sparse. The objectives of our study were to determine the structure, governance, and experience to date of established critical care organizations in North American academic medical centers. DES...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001200
更新日期:2015-10-01 00:00:00
abstract:OBJECTIVE:Nitric oxide regulates epithelial permeability and other properties of the intestinal mucosal barrier. It previously has been shown in animals that intestinal mucosal nitric oxide production is impaired during gut hypoperfusion. The study was performed to confirm the presence of intestinal mucosal nitric oxid...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000080489.67211.1F
更新日期:2003-08-01 00:00:00
abstract:OBJECTIVE:Emergency preservation and resuscitation (EPR) comprise a novel approach for resuscitation of exsanguination cardiac arrest victims. EPR uses a cold aortic flush to induce deep hypothermic preservation, followed by resuscitation with cardiopulmonary bypass. Development of a rat EPR model would enable study of...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000253398.61666.0D
更新日期:2007-02-01 00:00:00
abstract:OBJECTIVES:The electronic health record is a primary source of information for all professional groups participating in ICU rounds. We previously demonstrated that, individually, all professional groups involved in rounds have significant blind spots in recognition of patient safety issues in the electronic health reco...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003302
更新日期:2018-10-01 00:00:00
abstract:OBJECTIVE:To investigate if prone position delays the progression of experimental ventilator-induced lung injury, possibly due to a more homogeneous distribution of strain within lung parenchyma. DESIGN:Prospective, randomized, controlled trial. SETTING:Animal laboratory of a university hospital. SUBJECTS:Thirty-fiv...
journal_title:Critical care medicine
pub_type: 评论,杂志文章
doi:10.1097/01.ccm.0000150660.45376.7c
更新日期:2005-02-01 00:00:00
abstract:OBJECTIVES:Anaphylactic shock is associated with severe hypotension. Potassium channel blockers, such as 4-aminopyridine, induce vasoconstriction. The objective of this study was to test the ability of 4-aminopyridine to restore blood pressure and increase survival in anaphylactic shock. DESIGN:Experimental study. SE...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001822
更新日期:2016-11-01 00:00:00
abstract:OBJECTIVE:To develop a scheme for early identification of individuals at risk for symptomatic vasospasm after subarachnoid hemorrhage (SAH). DESIGN:Analysis of prospectively collected data from the placebo-treated group in a multicenter clinical trial. SETTINGS:Fifty-four neurosurgical centers in North America. MEAS...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/00003246-200004000-00012
更新日期:2000-04-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to examine the effect of proactive palliative care consultation on length of stay for high-risk patients in the medical intensive care unit (MICU). DESIGN:A prospective pre/post nonequivalent control group design was used for this performance improvement study. SETTING:Seventee...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000266533.06543.0C
更新日期:2007-06-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000611
更新日期:2015-01-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199304000-00021
更新日期:1993-04-01 00:00:00
abstract:OBJECTIVE:To evaluate premorbid conditions and sociodemographic characteristics associated with differences in hospitalization and mortality rates of sepsis in blacks and whites. DESIGN:Secondary data analysis of the publicly available New Jersey State Inpatient Database for 2002. SETTING:Acute care hospitals in New ...
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doi:10.1097/01.CCM.0000256726.80998.BF
更新日期:2007-03-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e318180ddf9
更新日期:2008-08-01 00:00:00
abstract::Suction applied to a chest-tube drainage system produces subambient pressure within the chest tube and may increase or decrease the flow of gas passing from the airway through a bronchopleural fistula. Such gas may have participated in gas exchange and contain more CO2 and less O2 than inspired gas. Calculated or meas...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198502000-00009
更新日期:1985-02-01 00:00:00
abstract::A case of rabies was treated with intensive medical support. This led to a prolongation of life to 25 days. The neurologic progression of the disease was monitored clinically and with serial EEG. This prolonged course enabled us to witness and manage a wide variety of unusual complications including the adult respirat...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:
更新日期:1989-08-01 00:00:00
abstract:OBJECTIVE:To assess the effects of dopexamine on splanchnic blood flow and splanchnic oxygen uptake in septic patients. DESIGN:A prospective, controlled trial. SETTING:A ten-bed intensive care unit (ICU) in a university hospital. PATIENTS:Twelve patients with severe sepsis (according to the criteria of the 1992 Amer...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-199910000-00015
更新日期:1999-10-01 00:00:00
abstract:OBJECTIVES:To assess the variability in short-term sepsis mortality by hospital among Centers for Medicare and Medicaid Services beneficiaries in the United States during 2013-2014. DESIGN:A retrospective cohort design. SETTING:Hospitalizations from 3,068 acute care hospitals that participated in the Centers for Medi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003324
更新日期:2018-11-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198206000-00005
更新日期:1982-06-01 00:00:00
abstract:OBJECTIVE:To examine the relationship between aminoglycoside disposition kinetics and hemodynamic response to sepsis, as well as vital support therapy, in critically ill patients with sepsis. DESIGN:Cross-sectional study of critically ill patients with sepsis undergoing physiologic and aminoglycoside pharmacokinetic m...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199705000-00016
更新日期:1997-05-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199405000-00027
更新日期:1994-05-01 00:00:00
abstract::End tidal CO2 tension (PetCO2) and transcutaneous CO2 tension (PtcCO2) were compared with arterial CO2 (PaCO2) before and after withdrawal of mechanical ventilation in 20 patients predisposed to hypercarbia. With stable PaCO2 during mechanical ventilation, the correlation coefficient (r) between PaCO2 and PetCO2 was ....
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198708000-00011
更新日期:1987-08-01 00:00:00
abstract:OBJECTIVE:Procalcitonin may be associated with reduced antibiotic usage compared to usual care. However, individual randomized controlled trials testing this hypothesis were too small to rule out harm, and the full cost-benefit of this strategy has not been evaluated. The purpose of this analysis was to evaluate the ef...
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1097/CCM.0b013e31821201a5
更新日期:2011-07-01 00:00:00