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Should we abandon corticosteroids during septic shock? No.
Arie Bastiaan Johan Groeneveld1, Nienke Molenaar, Bert Beishuizen
1Department of Intensive Care and Institute for Cardiovascular Research, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands. johan.groeneveld@vumc.nl
Current Opinion in Critical Care
|July 11, 2008
Summary
Corticosteroid treatment for septic shock remains controversial. While not improving mortality, stress doses may aid shock reversal, but further research is needed to identify optimal patient candidates.
Area of Science:
- Critical Care Medicine
- Endocrinology
- Infectious Diseases
Background:
- The use of corticosteroids in vasopressor-dependent septic shock is debated.
- The CORTICUS trial has added complexity to this discussion.
Purpose of the Study:
- To review the benefits and drawbacks of corticosteroid therapy in septic shock.
- To provide clinical and research recommendations.
Main Methods:
- Narrative review of existing literature.
- Analysis of findings from the CORTICUS trial.
Main Results:
- Corticosteroids showed benefit in shock reversal time but not mortality in the CORTICUS study.
- Increased superinfection risk may explain the lack of mortality benefit.
- Lower mortality in the CORTICUS placebo group compared to prior studies.
Conclusions:
- Corticosteroid treatment for septic shock should not be discontinued.
- Further studies are required to identify patient subgroups most likely to benefit.
- Current practice of administering hydrocortisone for refractory septic shock should continue, with rapid tapering based on hemodynamic response.
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