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Should Patients With Sepsis Be Treated With Steroids?

Roman Jaeschke, MD, MSc; Derek C. Angus, MD, MPH

JAMA. 2009;301(22):2388-2390.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Physicians who practiced medicine 25 years ago likely remember the use of high-dose intravenous steroids, such as 1-g boluses of methylprednisolone, for septic shock. The practice was fueled by anecdotes of miraculous recoveries, but large randomized trials failed to demonstrate benefit and raised the specter of possible harm. Steroids were abandoned and lay dormant for years, until recent studies suggested that septic shock may be exacerbated by relative adrenal insufficiency and that smaller dose of steroids for longer periods of time may be beneficial. In 2002, in a multicenter French study, Annane et al¹ reported lower mortality among patients in septic shock who were randomized to a 1-week course of low-dose steroids. This study ignited such rapid interest in steroids that the United States temporarily ran out of hydrocortisone. For those who lament the usually slow adoption of evidence into clinical . . . [Full Text of this Article]

Author Affiliations: Department of Medicine, McMaster University, Hamilton, Ontario, Canada (Dr Jaeschke); CRISMA Laboratory, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Angus). Dr Angus is also Contributing Editor, JAMA.

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