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Use of corticosteroids in septic shock
1Division of Pulmonary, Critical Care and Sleep Medicine, North Shore-Long Island Jewish Health System, Albert Einstein College of Medicine, New Hyde Park, NY, USA. rcohen@lij.edu
Minerva Anestesiologica
|November 25, 2010
Summary
Corticosteroids for septic shock show controversial results, with early high-dose studies lacking benefit. Lower doses for adrenal insufficiency remain debated, necessitating careful consideration of risks and benefits in critical illness.
Area of Science:
- Critical Care Medicine
- Endocrinology
- Pharmacology
Background:
- Corticosteroids are potent anti-inflammatory drugs used in various diseases.
- Septic shock involves a severe inflammatory response, suggesting potential corticosteroid use.
- Initial studies with high-dose corticosteroids in septic shock showed no benefit.
Purpose of the Study:
- To review the current evidence on corticosteroid use in septic shock.
- To discuss controversies surrounding low-dose corticosteroid therapy for relative adrenal insufficiency.
- To analyze shortcomings of major clinical trials and provide updated recommendations.
Main Methods:
- Review of existing literature and major multi-center, double-blind, randomized trials.
- Analysis of studies examining both high-dose and low-dose corticosteroid regimens.
- Evaluation of reported benefits, side effects, and controversial findings.
Main Results:
- Early high-dose corticosteroid trials in septic shock yielded no significant benefits.
- The efficacy of low-dose corticosteroids for relative adrenal insufficiency in septic shock remains controversial.
- Clinical trial data on corticosteroid benefits and harms in critical illness are conflicting.
Conclusions:
- The role of corticosteroids in septic shock is complex and debated.
- Balancing potential benefits against side effects of corticosteroids in critical illness requires careful consideration.
- Recent recommendations aim to clarify corticosteroid use in septic shock, addressing trial limitations.
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