Thursday October 20, 2005
Free cotisol - not 'ripe' yet !
April 15, 2004 NEJM article advocates using "free" cortisol level before initiating steroid therapy in critically ill patients but "free" cortisol is not part of the game yet ! Evidence (and guidelines) is still in favor of use of low dose steroid (+/- florinef) in septic shock. We need to wait for the result of substudy of CORTICUS trial (steroid therapy of septic shock) which will compare total and free cortisol levels in septic shock patients.
References: click on link to get article:
1. Serum Free Cortisol in Critically Ill Patients - NEJM
2. CORTICUS TRIAL - clinicaltrials.gov
3. Free cortisol levels should not be used to determine adrenal responsiveness - ccforum.com