Related Experiment Video
Updated: May 31, 2026
07:30
Design of Cecal Ligation and Puncture and Intranasal Infection Dual Model of Sepsis-Induced Immunosuppression
Published on: June 15, 2019
Systemic steroids in severe sepsis and septic shock
Gourang P Patel1, Robert A Balk
1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rush University Medical Center, Chicago, IL, USA.
Summary
Corticosteroid treatment for severe sepsis and septic shock shows benefits for blood pressure but not mortality. Current evidence is insufficient to guide optimal steroid use, necessitating further research.
Area of Science:
- Critical Care Medicine
- Endocrinology
- Pharmacology
Background:
- The use of corticosteroids in severe sepsis and septic shock has been debated for over 50 years.
- Existing data suggest potential benefits on systemic blood pressure in septic shock patients.
- Contradictory findings from recent trials complicate the understanding of corticosteroid efficacy on mortality.
Purpose of the Study:
- To review the current evidence on corticosteroid treatment in severe sepsis and septic shock.
- To identify the strengths and weaknesses of existing data regarding corticosteroid therapy.
- To guide clinicians on patient selection, dosing, and duration of corticosteroid treatment.
Main Methods:
- Evidence-based review of existing clinical trial data and meta-analyses.
- Analysis of experimental design flaws and biases in recent studies.
- Focus on differentiating effects of high-dose versus low-dose (physiologic) corticosteroid administration.
Main Results:
- High-dose corticosteroid treatment offers no benefit and may cause harm in septic patients.
- Low-dose corticosteroid trials have design flaws, limiting definitive conclusions on mortality benefits.
- Optimal patient selection, dosage, and treatment duration for corticosteroids remain unclear.
Conclusions:
- Current evidence is insufficient to definitively answer key questions about corticosteroid use in sepsis.
- Practicing clinicians should be informed about the limitations of current data.
- Future prospective, randomized, controlled trials are needed for definitive guidance.
Related Concept Videos
01:25Acute Inflammation III: Local and Systemic Effects
Acute inflammation produces a coordinated set of local and systemic changes that limit injury, eliminate pathogens, and initiate repair. These responses arise within minutes of infection, trauma, or chemical insult and are driven by vascular alterations and leukocyte-derived mediators. When the stimulus resolves, the reaction typically abates within days.Local EffectsAt the site of injury, arteriolar vasodilation increases blood flow, resulting in redness and warmth. Simultaneously, increased...
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2 (COX-2),...
01:28Pneumonia IV: Management
The treatment of pneumonia varies based on its severity and the causative pathogen. Here is a structured approach to managing pneumonia, integrating pharmaceutical and supportive care strategies.
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
01:25Antiasthma Drugs: Inhaled Corticosteroids and Glucocorticoids
Inhaled corticosteroids (ICS) are anti-inflammatory drugs used primarily in treating persistent asthma and providing long-term maintenance. They target the bronchial mucosa, the lining of the airways, to control inflammation, a critical factor in asthma progression and exacerbation.
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
01:23Acute Respiratory Failure-IV
Respiratory failure can manifest suddenly or gradually, characterized by a rapid decline in PaO2 and a rapid rise in PaCO2. This situation indicates a severe respiratory problem that may quickly become a life-threatening emergency. One of the early signs of hypoxemic Acute Respiratory Failure (ARF) is a change in mental status due to the brain's sensitivity to oxygen levels and changes in acid-base balance. Symptoms such as restlessness, confusion, and agitation suggest inadequate oxygen...