Risk factors and outcome of changes in adrenal response to ACTH in the course of critical illness.

Background: To evaluate the concept of critical illness-related corticosteroid insufficiency (CIRCI) by studying the clinical significance, in terms of risk factors and outcome, of changes in the cortisol response to repeated adrenocorticotropic hormone (ACTH) testing in the course of critical illness.

Patients And Methods: In a retrospective study in a medical-surgical intensive care unit (ICU) of a university hospital, we retrospectively included 54 consecutive patients during a 3-year period, who underwent 2 conventional 250 μg ACTH tests at an interval >24 hours, because of ≥6 hours hypotension requiring repeated fluid challenges or vasopressor/inotropic treatment, while corticosteroid treatment was not (yet) initiated. Serum cortisol was measured immediately before and 30 and 60 minutes after intravenous injection of 250 μg of ACTH.

Should we abandon corticosteroids during septic shock? No.

Purpose Of Review: With the publication of the results of the recent CORTICUS trial, stress ('low') doses of corticosteroids for the treatment of vasopressor-dependent septic shock in adults can still be considered controversial. The purpose of this narrative review is to elaborate the pros and cons of this treatment in clinical practice and to formulate clinical and research directions.

Recent Findings: The recent CORTICUS study only shows a beneficial effect of stress doses of corticosteroids in the time interval to shock reversal and not on mortality, potentially explained by an increased risk for superinfection.

Correlates of thenar near-infrared spectroscopy-derived tissue O2 saturation after cardiac surgery.

We studied the significance of near-infrared spectroscopy (NIRS), for measuring tissue oxygenation (S(t)O(2)) and perfusion adequacy, and thus for haemodynamic monitoring of patients after cardiac surgery. We compared NIRS-derived S(t)O(2) of the thenar muscle to haemodynamic variables, oxygenation indices, temperature, lactate levels and urinary output, in 23 patients in the course of time after cardiac surgery and admission into the intensive care unit. Clinical variables, global haemodynamics and NIRS% total haemoglobin (%HT) and S(t)O(2) in the thenar for up to 18-22 h after admission were measured.