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Published on: June 15, 2019
Corticosteroids in septic shock: a systematic review and network meta-analysis
Ben Gibbison1, José A López-López2, Julian P T Higgins3
1Cardiac Anaesthesia and Intensive Care, Bristol Heart Institute - University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK. mdbjjg@bristol.ac.uk.
Hydrocortisone, as a bolus or infusion, showed a higher likelihood of reversing septic shock compared to other corticosteroids or placebo. However, no significant differences were found for mortality or other adverse events in septic shock treatment.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Evidence-Based Medicine
Background:
- Septic shock management involves various corticosteroids and treatment regimens.
- Differences in drug properties and delivery impact cellular and tissue levels.
- Optimal corticosteroid choice for septic shock remains unclear.
Purpose of the Study:
- To compare the efficacy of different corticosteroids and regimens in adult septic shock.
- To identify differences in outcomes associated with corticosteroid therapy.
Main Methods:
- Network meta-analysis of existing Cochrane review data.
- Exclusion of pediatric studies and specific designs (e.g., cross-over).
- Frequentist approach with a random-effects model.
Main Results:
- No clear superiority of any intervention for most outcomes.
- Hydrocortisone (bolus/infusion) demonstrated higher efficacy in shock reversal.
- No significant differences in mortality, GI bleeding, or superinfection rates.
Conclusions:
- No single corticosteroid or regimen is consistently superior for septic shock outcomes.
- Hydrocortisone shows a benefit in achieving shock reversal.
- Further research may be needed to clarify optimal strategies.
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