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Corticosteroids and Septic Shock
Edward Abraham, MD;
Timothy Evans, MD
JAMA. 2002;288:886-887.
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The use of corticosteroid therapy in patients with sepsis and septic shock has a long and controversial history. The first study suggesting that steroids could prove beneficial in this patient population was published in 1951,1 and the results of more than 50 clinical investigations exploring this hypothesis have been published since.2-3 Early reports4 suggested that survival was improved; but subsequent large, randomized studies and meta-analyses failed to show a mortality benefit and have even indicated that steroid therapy may be harmful.2-3,5
Despite this historical burden, several small studies have suggested recently that glucocorticoids might afford clinical benefit to rigorously characterize groups of patients with infection complicated by hypotension unresponsive to fluids and by organ dysfunction.6-7 In particular, the high incidence of acquired adrenal insufficiency, or lack of adrenal reserve, in such critically ill patients has provided a strong rationale for the prolonged administration of . . . [Full Text of this Article]
Author Affiliations: Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center, Denver (Dr Abraham) and Unit of Critical Care, Imperial College of Science, Technology & Medicine, Royal Brompton Hospital, London, England (Dr Evans).
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