Corticosteroid after etomidate in Critically Ill
Transcript of Corticosteroid after etomidate in Critically Ill
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Giurfan tre}efzazbif
Jr Lbufk
]utersb}ir7 Jr ]`afzb. Jr Zab
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BFZ_I
Ezihbjaze epmennefz `ehijfahbmtricbne. cbr}z nbfe bfjumzbif akefz bf _]Bcir `ehijfahbmann uf}zaone tazbefz
}bfkne ji}e oniml} mirzb}in }fz`e}b}na}zbfk cir :0 `r} ti}z bfjumzbif ji}e
@bk`er raze} ic hirzanbz afj hirobjbz bf
BMU bf tazbefz} ajhbzzej cir zrauha ir}etzbm }`iml
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BFZ_I
Hijeraze ji}e `jrimirzb}ife ( ?44=44hk)ja"
isermihe mrbzbman bnnfe}}renazejajrefan bf}uccbmbefm. tarzbmunarn bf}etzbm tazbefz} re}tifjbfk tiirn zicnubj re}u}mbzazbif afj sa}itre}}ir
akefz} rejume} firajefanbfe requbrehefzbf orabf jeaj tazbefz}
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ABH
Zi bfse}zbkaze z`e eccemzbsefe}} ic
}uttnehefzazbif az jemrea}bfkz`e tritirzbif ic sa}itre}}irjetefjefz tazbefz} {bz`iuz }etzbm
}`imlaczer }bfkne ji}eezihbjaze&
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HEZ@IJ]
Tri}temzbse rafjihb}ej mifzrinnej jiuoneonbfj zrban Gun ?440 Gun ?414. bf ufbser}bz`i}tbzan bfmnujej = BMU}
Bfcirhej {rbzzef mif}efz tazbefz. renazbse}.
nekann auz`irb}ej retre}efzazbse} Tazbefz }enemzbif}7
Ajunz tazbefz} requbrbfk }ejazbif cir _]B bf
E_ ir bf z`e cbenj (ezihbjaze afj}upahez`ifbuh"
]ejazbif} hbjawinah. triticin.}ucefzafn afj cefzafn
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HEZ@IJ]
Epmnujej }etzbm }`iml , }zeribj m`rifbm ajrefan bf}uccbmbefm. tbzubzar j}cufmzbif.
@BS bfcemzbif. lezimifawine ir cnumifawine. tresbiu} mirzbmizrit`bf }zbhunazbif ze}z.}ursbsan>:0`r}.
5`r} ti}z bfjumzbif.}ejazbif {bz` ezihbjaze6 ?:`r}
Attrisej o niman ez`bm} mihbzzee
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]ZUJR T_IZIMIN
Bfjumzbif zbhe @4
U}ake ic ezihbjaze b} necz zi z`ejb}mrezbif ic t`}bmbaf bfm`arke
Tazbefz} {ere rafjihn a}}bkfej bf a171 razbi zi remebse ebz`er `jrimirzb}ifeir }anbfe crih @3 zi @:0
Mihtuzerb}ej rafjihb}azbif. `afjnejo }zazb}zbmbaf fiz bfsinsej
BMU t`}bmbaf} afj fur}e} onbfjej
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]ZUJR T_IZIMIN
Aczer 3 `iur} ic bfjumzbif ( mihtnezbif ic oniij}ahtnbfk cir z`e mirzbmizrit`bf ze}z"
mifzrin kriut 54hn} ic F] @M kriut ?44hk @M jbnuzej bf 54hn} }anbfe
A oinu} ic 1?&5 hN ic z`e }inuzbif. mifzabfbfk54 hk @M {a} bfbzbann bfgemzej iser =4 hbf} aza raze ic ?5 hN)`r&
Z`e }inuzbif {a} z`ef mifzbfuiu}n bfcu}ej aza raze ic
?&1 hN)`r ufzbn @:0. ufne}} z`e tazbefz {a}jb}m`arkej oecire`afj&
Bf zizan @M ?44hk)ja
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]ZUJR T_IZIMIN
Sarbaone} {ere minnemzej if ajhb}}bifafj
az 3. 1?. ?:. afj :0 `r} e}tembann z`e
marjbisa}munar ]equefzban Irkaf CabnureA}}e}}hefz (]ICA" }mire
HAT 3524 o firajrefanbfe bc requbrej
afj ZOB HAT 0424 Bf}unbf ajhbfb}zerej zi habfzabf knumi}e
>14hhin)n
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@I_HIFAN A]]AR
Ajrefan cufmzbif a}}e}}ej u}bfk `bk` ji}emirzbmizrit`bf }zbhunazbif ze}z
]eruh zizan mirzb}in afj mifmihbzafz 11O
jeipmirzb}in mifmefzrazbif} {erejezerhbfej az @5 afj 34 hbf} aczer z`e BSajhbfb}zrazbif ic ?54 hk ic }fz`ezbm 1?:ajrefimirzbmizritbm `irhife
]uo}equefz hea}urehefz} ic }eruh zizanmirzb}in afj 11Ojeipmirzb}inmifmefzrazbif} {ere tercirhej az @1?.@?:. afj @:0
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@I_HIFAN A]]AR
Ezihbjazerenazej ajrefan bf}uccbmbefm{a}
jecbfej a} m`afkebf }eruh mirzb}in
mifmefzrazbif} >?54 fhin)N (2 hmk)jN"aczer M]Z a}}imbazej {bz` }eruh 11Ojeipmirzb}in mifmefzrazbif} 60 fhin)N
(4&?0 hmk)jN"
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T_BHA_R IUZMIHE
Z`e trbhar }zuj iuzmihe {a} z`e miur}eic tazbefz} {bz` a marjbisa}munar ]ICA}mire ic = ir :. b&e&. requbrehefz icfiretbfet`rbfe zi zreaz hijerazezi}eseremarjbisa}munar cabnure az @3. @1?. @?:. afj@:0
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]EMIFJA_R IUZMIHE
miur}e ic firetbfet`rbfe ji}e hapbhuh }eruh knumi}e.
z`e fuhoer ic tazbefz} zreazej o bf}unbf. hapbhuh marjbisa}munar ]ICA }mire jurbfk z`e }zuj terbij& ?0ja annmau}e hirzanbz.
z`e jurazbif ic hem`afbman sefzbnazbif fuhoer ic BMU ja} {bz` firetbfet`rbfe
}uttirz&
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]ZAZB]ZBMAN AFANR]B]
]zazb}zbman afan}b} {a} tercirhej u}bfk]zaza ser}bif 11&4 (]zaza Mirt.Minneke]zazbif. ZP"&
]zazb}zbman }bkfbcbmafme {a} jemnarej{`ef t> &45&. ti{er 4&0
M`b }q(fif tarahezrbm" afj Haff[`bzfe ze}z} (mazekirbman)mifzbfuiu}"
Tazbefz} {bz` trehazure efjbfk ic z`e@M bfcu}bif {ere mif}bjerej bf z`eafan}b}
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_E]UNZ]
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_E]UNZ]
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@bk`er }eruh mirzb}in mifmefzrazbif} az @1?. @?:. afj @:0 bf z`e @M kriut mihtarej{bz` z`e mifzrin kriut
Z`e ammuhunazbif ic }eruh 11Ojeipmirzb}in trikre}}bsen jemnbfej iser zbhe (t >&41"{bz` fijbccerefme oez{eef z`e z{i kriut}
]eruh anouhbf m`af e} }bhbnar oez{eef oiz riu } >4&41
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]ICA }mire
Ann ic z`e}e tazbefz} remebsejfiretbfet`rbfe. afj jiouzahbfe {a}ajjbzbifann ajhbfb}zerej az }bhbnar
crequefmbe} bf z`e @M afj mifzrinkriut}
Bf z`e @M afj mifzrin kriut}. z`etritirzbif ic tazbefz} {bz`
marjbisa}munar ]ICA }mire} ic = ir :jemnbfej mihtaraon iser zbhe oez{eef@3 afj @:0 (t >&41"
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Heaf Arzerban Tre}}ure}
HAT mihtaraone oez{eef oiz` kriut}.{bz` `bk`er reajbfk} az @:0 s} @3
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Firajrefanbfe ji}e}
Zbhe renazej esinuzbif ic ji}e afjkriut
(t>4&41"
Ni{er ji}e} requbrej az @?: afj @:0s} @3 bf z`e @M kriut (t>4&41"
Fi jbccerefme} epb}zej rekarjbfk z`e
ji}e} ic jiouzahbfe oez{eef z`e z{ikriut}&
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]emifjar iuzmihe}
Fi }bkfbcbmafz jbccerefme epmetz `bk`erhapbhuh knumi}e nesen bf @M kriut
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JB]MU]]BIF]
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Bf z`b} }zujr
Mifmihbzzefz a}}e}}hefz ic nesen} ic }eruhmirzb}in afj 11Ojeipmirzb}in bf z`e }earm` cirezihbjazerenazej ajrefan bf}uccbmbefm&
(fuheriu} mau}e} ic arefan bf}uccbmbefm bf bnntazbefz}"
Z`e trikre}}bse jemnbfe bf }eruh 11Ojeipmirzb}in o :0 `r} mifcbrh} z`e zraf}befzonimlaje ic mirzb}in }fz`e}b} ti}z ezihbjaze
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Hijeraze ji}e @m jie} fiz m`afke z`etrbhar iuzmihe
]ukke}z} z`az ezihbjaze afj bz} re}unzbfkzraf}befz ajrefan jerafkehefz tna fi hagir
rine bf z`e esinuzbif ic marjbisa}munar }zazu}&
Ouz hi}z tazbefz} `aj }zaobnb}ej
`ehijfahbm} oecire remrubzhefz. hi}zorabf bfgur tresefzbif ic arzerban`tizef}bif tresefz ife hagir trejbmzir ictiir iuzmihe
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@M ajhbfb}zrazbif cir > :0`r} ef`afme}mazem`inahbfe }ef}bzbsbz . z`erecireHAT }zaone bfjetefjefz ic ezihbjaze
renazej ajrefimirzbman bf}uccbmbefm
Eptnabf} z`e }bkfbcbmafz jemrea}e bf
requbrej nesen} ic firajrefanbfe az @?:s} @:0`r}
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NBHBZAZBIF]
Jemb}bif cir ezihbjaze u}e b} az jbmrezbif icE_ t`}bmbaf. fiz bfsinsej bf }uo}equefzmare
Fi BMU bfzuoazbif}. z`erecire fizretre}efzazbse ic ann mnbfbman }bzuazbif} reqezihbjaze cir bfzuoazbif} e}t }etzbm }`iml
req sa}itre}}ir} @M kbsef az @3 fiz @4 ( if bfjumzbif" eccemz
{arrafz} curz`er BP
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A trikre}}bse bf`bobzbif ic z`eajrefimirzbmizritbm `irhife }fz`e}b}}emifjar zi @M bfcu}bif hbk`z oe
ti}}bone. eptnabfbfk a jemrea}ebf }eruhmirzb}in nesen
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MIFMNU]BIF
Mrbzbmann bnn tazbefz} {bz`iuz }etzbm }`imljbj fiz oefecbz crih @M ajhbfb}zerej zi
isermihe ezihbjazerenazej ajrefanbf}uccbmbefm&
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MIFMNU]BIF
Fi hagir eccemz} if `ehijfahbm}zazu} {ere ciufj bf z`e zreazej kriut&
Z`e}e cbfjbfk} }ukke}z z`az }bfkne ji}e
ezihbjaze miunj oe mif}bjerejbfmrbzbmann bnn tazbefz} ufjerkibfk _]Bbfz`e cbenj ir bf z`e eherkefm riih
{bz`iuz hagir mifmerf} aoiuz bz} jrukbfjumej `irhifan jerafkehefz&
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ATT_AB]AN
[a} z`e a}}bkfhefz ic tazbefz} zizreazhefz} rafjihb}ej9
_afjihbwazbif {a} a}}urej u}bfk a
mihtuzerbwej rafjihfuhoer keferazir nb}z [ere z`e kriut} }bhbnar az z`e }zarz ic
z`e zrban9
Re}. mihtaraone oa}enbfe m`aramzerb}zbm}
00% }`i{ej ezihbjaze renazej ajrefanbf}uccbmbefm
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[ere ann tazbefz} {`i efzerej z`e zrbanammiufzej cir9 afj {ere z`e afan}ej
bf z`e kriut} zi {`bm` z`e {ererafjihb}ej9
RE] . ann tazbefz} cinni{ej ut zbnn :0`r} cirtrbhar iuzmihe&
Trehazure efjbfk ic @M bfcu}bif} afan}ej
(bfzefzbif zi zreaz"
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[ere hea}ure} iogemzbse ir {ere z`etazbefz} afj mnbfbmbaf} letz onbfj zi
{`bm` zreazhefz {a} oebfk remebsej9
Re}. bfse}zbkazir} afj fur}e} letz onbfjej
@i{ tremb}e {a} z`e e}zbhaze ic z`ezreazhefz eccemz9
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Attnbmaobnbz
Ezihbjaze maf oe u}ej bf orabf bfgurtazbefz} a} z`e rb}l ic arzerban `tizef}bifiuz{ebk`} z`e oefecbz ic fiz u}bfk
Ajrefan }uttre}}bif fiz a} }esere . @M}uttnehefzazbif jie} fiz anzer z`e miur}e
ic z`e bnnfe}}
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Z`afl iu