Annane corticosteroids

Results  One patient from the corticosteroid group was excluded from analyses because of consent withdrawal. There were 229 nonresponders to the corticotropin test (placebo, 115; corticosteroids, 114) and 70 responders to the corticotropin test (placebo, 34; corticosteroids, 36). In nonresponders, there were 73 deaths (63%) in the placebo group and 60 deaths (53%) in the corticosteroid group (hazard ratio, ; 95% confidence interval, -; P = .02). Vasopressor therapy was withdrawn within 28 days in 46 patients (40%) in the placebo group and in 65 patients (57%) in the corticosteroid group (hazard ratio, ; 95% confidence interval, -; P = .001). There was no significant difference between groups in responders. Adverse events rates were similar in the 2 groups.

The best type of fluid replacement and optimal volume of resuscitation in the setting of severe sepsis have been heavily debated but studies have provided guidance to the clinician. One trial comparing 4% albumin with normal saline for fluid resuscitation found no difference in mortality at 28 days. 24 A 2004 meta-analysis similarly found no mortality advantage with the use of colloids compared with the use of crystalloids. 25 The trial of EGDT revealed that patients in the treatment arm received far greater volumes of fluid in the first 6 hours of resuscitation than those in the control arm. In a large study of European ICUs, patients with a positive fluid balance at 72 hours had a poor outcome. 26 In a clinical trial of patients with acute lung injury, the use of a conservative fluid strategy targeting a CVP lower than 4 mm Hg and a pulmonary artery occlusion pressure (PAOP) lower than 8 mm Hg was associated with a fewer number of ICU and ventilators days. 27 The preponderance of data would suggest that aggressive fluid management be done in the acute phase of sepsis, followed by a more conservative phase in the following few days.

Corticosteroids reduced 28-day mortality (27 trials; n = 3176; risk ratio ( RR ) , 95% confidence interval ( CI ) to ; P value = , random-effects model). The quality of evidence for this outcome was downgraded from high to low for imprecision (upper limit of 95% CI = 1) and for inconsistency (significant heterogeneity across trial results). Heterogeneity was related in part to the dosing strategy. Treatment with a long course of low-dose corticosteroids significantly reduced 28-day mortality (22 trials; RR , 95% CI to ; P value = , fixed-effect model). The quality of evidence was downgraded from high to moderate for inconsistency (owing to non-significant effects shown by one large trial ). Corticosteroids also reduced mortality rate in the intensive care unit (13 trials; RR , 95% CI to ; P value = , random-effects model) and at the hospital (17 trials; RR , 95% CI to ; P value = , random-effects model). Quality of the evidence for in-hospital mortality was downgraded from high to moderate for inconsistency and imprecision (upper limit of 95% CI for RR approaching 1). Corticosteroids increased the proportion of shock reversal by day seven (12 trials; RR , 95% CI to ; P value = ) and by day 28 (seven trials; n = 1013; RR , 95% CI to ; P value = ) and reduced the SOFA score by day seven (eight trials; mean difference ( MD ) -, 95% CI - to -; P value < , random-effects model) and survivors' length of stay in the intensive care unit (10 trials; MD -, 95% CI - to -; P value = , fixed-effect model) without inducing gastroduodenal bleeding (19 trials; RR , 95% CI 0. 92 to ; P value = , fixed-effect model), superinfection (19 trials; RR , 95% CI to ; P value = , fixed-effect model) or neuromuscular weakness (three trials; RR , 95% CI to ; P value = , fixed-effect model). Corticosteroid increased the risk of hyperglycaemia (13 trials; RR , 95% CI to ; P value < , fixed-effect model) and hypernatraemia (three trials; RR , 95% CI to ; P value < , fixed-effect model).

Annane corticosteroids

annane corticosteroids

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