Anesthesiology 2020 08;133(2):439-457
From the School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (G.D.N., C.F.) the Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Queensland, Australia (G.D.N.) the Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia (G.D.N., J.C., J.L.) The George Institute, Sydney, New South Wales, Australia (J.C.) The Wesley Hospital, Brisbane, Queensland, Australia (J.C.) Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia (J.C., J.L.) Nimes University Hospital, University of Montpellier, Nimes, France (J.L.) the Institute for Cellular and Molecular Medicine, Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa (R.A.).
The recent demonstration of the significant reduction in mortality in patients with septic shock treated with adjunctive glucocorticoids combined with fludrocortisone and the effectiveness of angiotensin II in treating vasodilatory shock have renewed interest in the role of the mineralocorticoid axis in critical illness. Glucocorticoids have variable interactions at the mineralocorticoid receptor. Similarly, mineralocorticoid receptor-aldosterone interactions differ from mineralocorticoid receptor-glucocorticoid interactions and predicate receptor-ligand interactions that differ with respect to cellular effects. Read More