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• W2114093350 abstract "Recently, two double-blind studies [1, 2] revealed that stress doses of hydrocortisone given in patients with septic shock reduce the time to shock reversal. The earlier weaning from vasopressor therapy was associated with a trend towards improvements in organ dysfunction and mortality. These two studies on hydrocortisone [1, 2] were inspired by data from previous observational studies on hydrocortisone replacement [3, 4] undertaken with the assumption that a relative adrenal insufficiency contributes to septic shock [3, 5]. Although septic shock and adrenal insufficiency share some similar hemodynamic abnormalities such as hyperdynamic shock and peripheral vasodilation, relative adrenal insufficiency does not appear to explain the observed effects of hydrocortisone replacement [1, 6, 7]. In sepsis, plasma Cortisol levels are usually normal or elevated, thus ruling out adrenal insufficiency [8]. Consensus has been reached that plasma Cortisol concentrations of more than 20 to 25 μg/dl are sufficient for tissue requirements in sepsis [7–9]. However, glucocorticoid physiology and regulation substantially change during the course of septic shock. The integrity of the hypothalamic-pituitary-adrenal (HPA) axis and the function of cellular glucocorticoid receptors are altered in different ways. This chapter will focus on changes in glucocorticoid physiology and regulation during septic shock and will discuss the effects of these changes on immune response and vascular tone." @default.
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• W2114093350 date "1999-01-01" @default.
• W2114093350 modified "2023-09-23" @default.
• W2114093350 title "Stress Doses of Hydrocortisone in Septic Shock: Beyond the Hemodynamic Effects" @default.
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• W2114093350 doi "https://doi.org/10.1007/978-3-662-13453-5_18" @default.
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