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Corticosteroids for Septic Shock: Another Chapter in the Saga.
Jason Yerke1, Kyle Strnad1, Seth R Bauer1
1Cleveland Clinic, OH, USA.
Hospital Pharmacy
|March 28, 2020
Summary
Corticosteroids may benefit septic shock patients with organ failure refractory to vasopressors. However, consistent mortality benefits are not demonstrated, and judicious use is advised due to potential adverse effects.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Infectious Diseases
Background:
- Corticosteroid use in septic shock is controversial.
- Conflicting trial data and varied clinical practices exist.
- A clear role for corticosteroids in septic shock remains undefined.
Purpose of the Study:
- To critically analyze recent data on corticosteroids in septic shock.
- To provide an updated perspective on their clinical role.
- To reconcile historical debates with current evidence.
Main Methods:
- Review of recently published data and historical trials.
- Analysis of fluctuating study designs and patient populations.
- Critical appraisal of evidence regarding mortality benefits and adverse effects.
Main Results:
- Corticosteroids combat hyperinflammation and vasodilation.
- Clinical benefits have not consistently translated to mortality benefits.
- Recent large trials continue to show diverging viewpoints on mortality.
Conclusions:
- Hydrocortisone may benefit septic shock patients with vasopressor-refractory organ failure.
- Use in other settings lacks demonstrated mortality benefit and carries risks.
- Judicious application is recommended, considering potential adverse effects.
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