naa a22 4500 510743293 CHVBK 20180411083035.0 cr unu---uuuuu 180411e20130701xx s 000 0 eng 10.1007/s12630-013-9929-3 doi (NATIONALLICENCE)springer-10.1007/s12630-013-9929-3 Corticosteroid use in the intensive care unit: a survey of intensivists [Elektronische Daten] [François Lamontagne, Hector Quiroz Martinez, Neill Adhikari, Deborah Cook, Karen Koo, François Lauzier, Alexis Turgeon, Michelle Kho, Karen Burns, Clarence Chant, Rob Fowler, Ivor Douglas, Yannick Poulin, Karen Choong, Niall Ferguson, Maureen Meade] Utilisation de corticostéroïdes à l'unité des soins intensifs: sondage auprès des intensivistes Objective: The efficacy of systemic corticosteroids in many critical illnesses remains uncertain. Our primary objective was to survey intensivists in North America about their perceived use of corticosteroids in clinical practice. Design: Self-administered paper survey. Population: Intensivists in academic hospitals with clinical trial expertise in critical illness. Measurements: We generated questionnaire items in focus groups and refined them after assessments of clinical sensibility and test-retest reliability and pilot testing. We administered the survey to experienced intensivists practicing in selected North American centres actively enrolling patients in the multicentre Oscillation for ARDS Treated Early (OSCILLATE) Trial (ISRCTN87124254). Respondents used a four-point scale to grade how frequently they would administer corticosteroids in 14 clinical settings. They also reported their opinions on 16 potential near-absolute indications or contraindications for the use of corticosteroids. Main results: Our response rate was 82% (103/125). Respondents were general internists (50%), respirologists (22%), anesthesiologists (21%), and surgeons (7%) who practiced in mixed medical-surgical units. A majority of respondents reported almost always prescribing corticosteroids in the setting of significant bronchospasm in a mechanically ventilated patient (94%), recent corticosteroid use and low blood pressure (93%), and vasopressor-refractory septic shock (52%). Although more than half of respondents stated they would almost never prescribe corticosteroids in severe community-acquired pneumonia (81%), acute lung injury (ALI, 76%), acute respiratory distress syndrome (ARDS, 65%), and severe ARDS (51%), variability increased with severity of acute lung injury. Near-absolute indications selected by most respondents included known adrenal insufficiency (99%) and suspicion of cryptogenic organizing pneumonia (89%), connective tissue disease (85%), or other potentially corticosteroid-responsive illnesses (85%). Conclusions: Respondents reported rarely prescribing corticosteroids for ALI, but accepted them for bronchospasm, suspected adrenal insufficiency due to previous corticosteroid use, and vasopressor-refractory septic shock. These competing indications will complicate the design and interpretation of any future large-scale trial of corticosteroids in critical illness. Canadian Anesthesiologists' Society, 2013 Lamontagne François Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada aut Quiroz Martinez Hector Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada aut Adhikari Neill Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada aut Cook Deborah Departments of Medicine, Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada aut Koo Karen Department of Medicine, University of Western Ontario, Toronto, ON, Canada aut Lauzier François Centre de Recherche FRQ-S du CHU de Québec, Division of Critical Care, Departments of Anesthesiology and Medicine, Université Laval, Québec City, QC, Canada aut Turgeon Alexis Centre de Recherche FRQ-S du CHU de Québec, Division of Critical Care, Department of Anesthesiology, Université Laval, Québec City, QC, Canada aut Kho Michelle Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA aut Burns Karen Department of Critical Care and the Keenan Research Centre/Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada aut Chant Clarence Pharmacy Department, St Michael's Hospital, Keenan Research Centre at Li Ka Shing Knowledge Institute, Toronto, ON, Canada aut Fowler Rob Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada aut Douglas Ivor Pulmonary Sciences & Critical Care Medicine, Denver Health and University of Colorado, School of Medicine, Denver, CO, USA aut Poulin Yannick Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada aut Choong Karen Departments of Pediatrics and Critical Care, McMaster University, Hamilton, ON, Canada aut Ferguson Niall Interdepartmental Division of Critical Care, and Department of Medicine, Division of Respirology, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada aut Meade Maureen Departments of Medicine, Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada aut Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer-Verlag 60/7(2013-07-01), 652-659 0832-610X 60:7<652 2013 60 12630 https://doi.org/10.1007/s12630-013-9929-3 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12630-013-9929-3 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Lamontagne François Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada aut NATIONALLICENCE 700 1- Quiroz Martinez Hector Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada aut NATIONALLICENCE 700 1- Adhikari Neill Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Cook Deborah Departments of Medicine, Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada aut NATIONALLICENCE 700 1- Koo Karen Department of Medicine, University of Western Ontario, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Lauzier François Centre de Recherche FRQ-S du CHU de Québec, Division of Critical Care, Departments of Anesthesiology and Medicine, Université Laval, Québec City, QC, Canada aut NATIONALLICENCE 700 1- Turgeon Alexis Centre de Recherche FRQ-S du CHU de Québec, Division of Critical Care, Department of Anesthesiology, Université Laval, Québec City, QC, Canada aut NATIONALLICENCE 700 1- Kho Michelle Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Burns Karen Department of Critical Care and the Keenan Research Centre/Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Chant Clarence Pharmacy Department, St Michael's Hospital, Keenan Research Centre at Li Ka Shing Knowledge Institute, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Fowler Rob Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Douglas Ivor Pulmonary Sciences & Critical Care Medicine, Denver Health and University of Colorado, School of Medicine, Denver, CO, USA aut NATIONALLICENCE 700 1- Poulin Yannick Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada aut NATIONALLICENCE 700 1- Choong Karen Departments of Pediatrics and Critical Care, McMaster University, Hamilton, ON, Canada aut NATIONALLICENCE 700 1- Ferguson Niall Interdepartmental Division of Critical Care, and Department of Medicine, Division of Respirology, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Meade Maureen Departments of Medicine, Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada aut NATIONALLICENCE 773 0- Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer-Verlag 60/7(2013-07-01), 652-659 0832-610X 60:7<652 2013 60 12630 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer