Corticosteroid Therapy in Patients with Severe Sepsis and Septic Shock

Didier Keh; Serge Goodman; Charles L. Sprung

doi:10.1055/s-2004-860985

Seminars in Respiratory and Critical Care Medicine, Table of Contents

Semin Respir Crit Care Med 2004; 25(6): 713-719
DOI: 10.1055/s-2004-860985

Corticosteroid Therapy in Patients with Severe Sepsis and Septic Shock

Didier Keh¹ , Serge Goodman² , Charles L. Sprung²

¹Department of Anesthesiology and Intensive Care Medicine, Charité - Campus Virchow-Klinikum, Humboldt University, Berlin, Germany
²Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel

Abstract

ABSTRACT

Corticosteroids have been considered for decades for the treatment of severe sepsis and septic shock, based on their pivotal role in the stress response and their hemodynamic and antiinflammatory effects. Whereas short-term therapy with high doses of corticosteroids (up to 42 g hydrocortisone equivalent for 1-2 days) has been ineffective or potentially harmful, prolonged therapy with lower doses (200-300 mg hydrocortisone for 5-7 days or longer) in septic shock has recently revealed beneficial effects in several randomized, controlled trials. Assuming relative adrenal insufficiency (RAI) and peripheral cortisol resistance, treatment with low-dose hydrocortisone improved shock reversal, reduced inflammation, and improved outcome. Shock reversal and reduction of mortality were more effective in patients with RAI, and most significant in patients with severe shock. Diagnosis of RAI with corticotropin tests in septic shock, however, is highly dependent on cut-off values and definition of RAI. Thus, it is not clear yet which patients benefit most from low-dose hydrocortisone and if treatment should be restricted to patients with RAI. In addition the role of fludrocortisone is uncertain. Nevertheless, based on current data, low-dose hydrocortisone therapy should definitely be considered in vasopressor-dependent septic shock. This review will address some critical points.

KEYWORDS

Septic shock - sepsis - corticosteroids - low-dose hydrocortisone - adrenal insufficiency

Full Text

References

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Didier KehM.D.

Department of Anesthesiology and Intensive Care Medicine, Charité-Campus Virchow-Klinikum, Humboldt University

Augustenburger Platz 1, D-13353 Berlin, Germany

Email: didier.keh@charite.de