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Related Experiment Videos

Steroids for septic shock: back from the dead? (Con).

Curtis N Sessler1

  • 1Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University Health System, Medical College of Virginia Hospitals, Richmond 23298, USA. csessler@hsc.vcu.edu

Chest
|May 13, 2003
PubMed
Summary

Corticosteroid therapy for septic shock remains controversial. While high-dose steroids show no benefit, low-dose hydrocortisone may improve survival in specific patients with relative adrenal insufficiency.

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Area of Science:

  • Critical Care Medicine
  • Endocrinology
  • Pharmacology

Background:

  • The use of corticosteroid therapy in septic shock management has been debated for decades.
  • High-dose, short-duration corticosteroids (methylprednisolone, dexamethasone) at shock onset show no benefit and potential harm.
  • Evidence suggests "relative adrenal insufficiency" and altered receptor sensitivity in sepsis warrant further investigation.

Purpose of the Study:

  • To evaluate the efficacy of modest-dose hydrocortisone therapy in patients with septic shock.
  • To investigate the role of relative adrenal insufficiency in treatment response.

Main Methods:

  • A multicenter, placebo-controlled clinical trial was conducted.
  • Patients received modest doses (200-300 mg/d) of hydrocortisone for 1-3 weeks.

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  • Response to corticotropin injection was used to assess adrenal function.

    • Main Results:

    • Patients with septic shock and poor response to corticotropin (indicating relative adrenal insufficiency) showed improved survival rates.
    • Faster cessation of vasopressor use was observed in this subgroup.
    • A trend towards higher mortality was noted in corticotropin responders.

    Conclusions:

    • Modest-dose hydrocortisone therapy may benefit septic shock patients with relative adrenal insufficiency.
    • Further research is needed to clarify the role of corticosteroids and address potential confounding factors like true adrenal insufficiency.