alexa Critical Illness Related Corticosteroid Insufficiency in Trauma - A Review
ISSN: 2167-1222

Journal of Trauma & Treatment
Open Access

OMICS International organises 3000+ Global Conferenceseries Events every year across USA, Europe & Asia with support from 1000 more scientific Societies and Publishes 700+ Open Access Journals which contains over 50000 eminent personalities, reputed scientists as editorial board members.

Open Access Journals gaining more Readers and Citations

700 Journals and 15,000,000 Readers Each Journal is getting 25,000+ Readers

This Readership is 10 times more when compared to other Subscription Journals (Source: Google Analytics)

Review Article

Critical Illness Related Corticosteroid Insufficiency in Trauma - A Review

Mark L. Walker*
Department of Surgery, Atlanta Medical Center, 303 Parkway Drive Atlanta, Georgia 30303, USA
Corresponding Author : Mark L. Walker
Department of Surgery, Atlanta Medical Center
303 Parkway Drive Atlanta, Georgia 30303, USA
E-mail: [email protected]
Received May 27, 2012; Accepted June 14, 2012; Published June 18, 2012
Citation: Walker ML (2012) Critical Illness Related Corticosteroid Insufficiency in Trauma – A Review. J Trauma Treat 1:139. doi:10.4172/2167-1222.1000139
Copyright: © 2012 Walker ML. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
 

Abstract

Critical Illness Related Corticosteroid Insufficiency is an intense inflammatory condition associated with steroid tissue resistance. Although traditionally felt to be uncommon, it is being increasingly recognized in severely stressed patients with prolonged intensive care unit stays. Over the last decade the spectrum of CIRCI in trauma has been better defined. Trauma patients with CNS (brain and or spinal cord) injury, burns or blunt multisystem injury are at particular risk. The diagnosis is best established using a random cortisol level combined with an Adrenocorticotrophic Hormone (ACTH) stimulation test. A low cortisol level and or a low response to the ACTH stimulation test in the setting of refractory shock makes the diagnosis. Stress dose hydrocortisone therapy is essential and improves outcome. CIRCI should be suspected in any elderly trauma victim with a prolonged ICU stay that exhibits shock. Drugs known to inhibit cortisol synthesis (like etomidate) are probably best avoided in this trauma subset. CIRCI in trauma has a bimodal distribution. The first peak occurs early (within 48 hours) after injury and is associated with shock and the attendant inflammatory response. The second peak occurs a week or more into the hospital course. This peak is usually associated with sepsis. Inflammatory cytokines (particularly IL-6) are elevated during both peaks but their exact role in establishing the diagnosis remains unclear. Physicians continue to search for the Eucorticoid state that achieves a balance between the inflammation initiated by the injury and the anti-inflammatory response anchored by endogenous steroid production. The administration of exogenous steroids to achieve this balance is an approach that seems to hold promise.

Keywords

Share This Page

Additional Info

Loading
Loading Please wait..
 
Peer Reviewed Journals
 
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
 
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri, Food, Aqua and Veterinary Science Journals

Dr. Krish

[email protected]

1-702-714-7001 Extn: 9040

Clinical and Biochemistry Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Business & Management Journals

Ronald

busines[email protected]

1-702-714-7001Extn: 9042

Chemical Engineering and Chemistry Journals

Gabriel Shaw

[email protected]

1-702-714-7001 Extn: 9040

Earth & Environmental Sciences

Katie Wilson

[email protected]

1-702-714-7001Extn: 9042

Engineering Journals

James Franklin

[email protected]

1-702-714-7001Extn: 9042

General Science and Health care Journals

Andrea Jason

[email protected]

1-702-714-7001Extn: 9043

Genetics and Molecular Biology Journals

Anna Melissa

[email protected]

1-702-714-7001 Extn: 9006

Immunology & Microbiology Journals

David Gorantl

[email protected]

1-702-714-7001Extn: 9014

Informatics Journals

Stephanie Skinner

[email protected]

1-702-714-7001Extn: 9039

Material Sciences Journals

Rachle Green

[email protected]

1-702-714-7001Extn: 9039

Mathematics and Physics Journals

Jim Willison

[email protected]

1-702-714-7001 Extn: 9042

Medical Journals

Nimmi Anna

[email protected]

1-702-714-7001 Extn: 9038

Neuroscience & Psychology Journals

Nathan T

[email protected]

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

John Behannon

[email protected]

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

[email protected]

1-702-714-7001 Extn: 9042

 
© 2008-2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version
adwords