Journal Article

Hydrocortisone Therapy for Patients with Septic Shock

Sprung, Charles L, Briegel, Josef, Kalenka, Armin, Freivogel, Klaus, Payen, Didier, Reinhart, Konrad, Forst, Helmuth, Annane, Djillali, Singer, Mervyn, Benbenishty, Julie, Moreno, Rui, Weiss, Yoram G, Laterre, Pierre-Francois, Keh, Didier, Cuthbertson, Brian H

2008

Overview

The benefit of adjuvant use of corticosteroids in patients with septic shock remains controversial. In this international, multicenter, double-blind, placebo-controlled trial, adjunctive therapy with hydrocortisone in nearly 500 patients with septic shock was not found to be clinically helpful. This lack of benefit was also found in a subgroup of patients who did not have a response to a corticotropin test. Adjunctive therapy with hydrocortisone in nearly 500 patients with septic shock was not found to be clinically helpful. This lack of benefit was also found in a subgroup of patients who did not have a response to a corticotropin test. Severe sepsis is a major cause of mortality and morbidity worldwide. 1 , 2 Septic shock, the most severe manifestation, occurs in 2 to 20% of inpatients. 3 The incidence of the condition has been rising, 4 and a death rate of 33 to 61% has been reported in the placebo groups of multicenter trials. 5 – 8 The use of corticosteroids as an adjunctive therapy has been controversial for decades. 9 After the study by Schumer, 10 a short course of high-dose corticosteroids became accepted therapy. Subsequent studies, however, did not confirm a survival benefit with this regimen and suggested an increase in superinfection-related mortality. 11 – 13 Studies . . .

• Publisher: Massachusetts Medical Society
• Subject: Adrenal Glands - drug effects / Adrenal Glands - metabolism / Adrenocorticotropic Hormone - pharmacology / Adult / Aged / Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy / Anesthetics, Intravenous - pharmacology / Anti-Inflammatory Agents - adverse effects / Anti-Inflammatory Agents - metabolism / Anti-Inflammatory Agents - therapeutic use / Biological and medical sciences / Clinical trials / Consent / Double-Blind Method / Drug dosages / Drug therapy / Drug Therapy, Combination / Emergency and intensive care: infection, septic shock / Etomidate - pharmacology / Female / General aspects / Hormones - pharmacology / Humans / Hydrocortisone - adverse effects / Hydrocortisone - metabolism / Hydrocortisone - therapeutic use / Injections, Intravenous / Intensive care medicine / Kaplan-Meier Estimate / Male / Medical sciences / Mental competency / Middle Aged / Shock, Septic - drug therapy / Shock, Septic - microbiology / Shock, Septic - mortality / Studies / Treatment Failure