Systemic Steroids in Severe Sepsis and Septic Shock.
Am J Respir Crit Care Med. 2011 Jun 16;
Authors: Patel GP, Balk RA
Despite over five decades of study and debate, the role of corticosteroid treatment in patients with severe sepsis and septic shock remains controversial. Data supports a beneficial effect on systemic blood pressure in patients with septic shock. However, the ability of corticosteroid therapy to improve mortality in patients with severe sepsis and septic shock remains controversial with contradictory results from recent large multicenter clinical trials. While it appears clear that high dose corticosteroid treatment provides no benefit and possibly harm in septic patients, the experimental design flaws and biases of recent low dose (physiologic) steroid treatment trials limits their ability to provide adequate answers to the important questions of which septic patients should be treated, how much steroid to give, and the optimum duration of treatment. Unfortunately, the answer to these important questions is not readily evident based on the current evidence or the application of meta-analysis to the available clinical data. This concise evidence-based review will highlight the strengths and weaknesses of the current data to inform the practicing clinician as to which patients are likely to derive significant benefit from corticosteroid treatment, while we await more definitive guidance from future multi-centered, prospective, randomized, controlled trials designed to better answer these important therapeutic questions.
PMID: 21680949 [PubMed - as supplied by publisher]