Corticosteroid Treatment in Septic Shock

Jiao Liu; Qian Xing; Xiaojun Pan; Sheng Zhang; Dechang Chen; Djillali Annane

doi:10.1055/a-2694-4823

Seminars in Respiratory and Critical Care Medicine, Table of Contents

Semin Respir Crit Care Med
DOI: 10.1055/a-2694-4823

Review Article

Corticosteroid Treatment in Septic Shock

Authors

Jiao Liu^‡

¹Department of Critical Care Medicine, Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, Shanghai, China
Qian Xing^‡

²Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, China

³Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
Xiaojun Pan

¹Department of Critical Care Medicine, Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, Shanghai, China
Sheng Zhang

¹Department of Critical Care Medicine, Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, Shanghai, China
Dechang Chen

¹Department of Critical Care Medicine, Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, Shanghai, China
Djillali Annane

⁴Department of Intensive Care, APHP University Versailles Saint Quentin, University Paris Saclay, Raymond Poincaré Hospital, Garches, France

⁵SEPSIS Institute, Institut Hospitalo Universitaire IHU-3, Garches, France

⁶Laboratory of Infection and Inflammation, U1173, School of Medicine, INSERM, University Versailles Saint Quentin, University Paris Saclay, Garches, France

Abstract

Septic shock, the most severe manifestation of sepsis, is characterized by profound circulatory failure and carries the highest mortality risk among sepsis-related conditions. Current therapeutic strategies remain primarily supportive, emphasizing empirical antimicrobial therapy and advanced organ system support. The immunomodulatory properties of corticosteroids in sepsis pathophysiology have been extensively investigated since the 1970s, though current guidelines recommend corticosteroid therapy for sepsis patients, albeit with a weak evidence base. In this review, we explore the molecular underpinnings of corticosteroid activity in septic shock and clinical evidence from randomized controlled trials, with a special emphasis on the stabilization of hemodynamics and the impact on mortality outcomes. Furthermore, we analyze recent advances in pharmacodynamic understanding that may inform more targeted corticosteroid administration in septic shock.

Keywords

molecular biology - pharmacology - preclinical models - clinical trials - systematic reviews - guidelines

Full Text

References

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