Adjunctive Glucocorticoid Therapy in Patients with Septic Shock

Venkatesh, Balasubramanian; Finfer, Simon; Cohen, Jérémy; Rajbhandari, Dorrilyn; Arabi, Yaseen M.; Bellomo, Rinaldo; Billot, Laurent; Correa, Maryam; Glass, Parisa; Harward, Meg; Joyce, Christopher; Li, Qiang; McArthur, Colin; Perner, Anders; Rhodes, Andrew; Thompson, Kelly; Webb, Steve; Myburgh, John

doi:10.1056/nejmoa1705835

Cited by 722 publications

(733 citation statements)

References 35 publications

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“…Total mortality consequently was 46.1%. In contrast, one study did not show a benefit with corticosteroid administration . Inclusion criteria for this study required any vasopressor use for a minimum of 4 hours, and total mortality rate was 28.3%.…”

Section: Corticosteroidsmentioning

confidence: 90%

“…The benefits of low‐dose corticosteroids on shock reversal were first reported in 1991 . Since then, numerous RCTs have evaluated the effect of low‐dose steroids on shock reversal and mortality (Table ) . Although there are some differences in the regimens used (dose and duration), the method for administration (bolus vs continuous infusion), and the use of a taper, these studies have collectively shown an improvement in shock reversal with low‐dose steroid therapy.…”

Section: Corticosteroidsmentioning

confidence: 99%

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Catecholamine Vasopressor Support Sparing Strategies in Vasodilatory Shock

et al. 2019

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Shock syndromes are associated with unacceptably high rates of mortality in critically ill patients despite advances in therapeutic options. Vasodilatory shock is the most common type encountered in the intensive care unit. It is manifested by cardiovascular failure, peripheral vasodilatation, and arterial hypotension leading to tissue hypoperfusion and organ failure. Hemodynamic support is typically initiated with fluid resuscitation strategies and administration of adrenergic vasopressor agents in nonresponsive patients to restore arterial pressure with subsequent adequate organ reperfusion. Unfortunately, high catecholamine dosing requirements may be necessary to achieve targeted hemodynamic goals that may increase the risk of vasopressor‐induced adverse events. The purpose of this article is to review the clinical efficacy and safety data and potential role in therapy for catecholamine‐sparing agents in vasodilatory shock. Adjunctive therapeutic options to reduce vasoactive support requirements without compromising arterial pressure include arginine vasopressin and analogs, corticosteroids, midodrine, methylene blue, and angiotensin II. Although concomitant vasopressin and corticosteroids have a more defined role in evidence‐based guidelines for managing shock, clinicians may consider other potential catecholamine‐sparing agents.

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Section: Corticosteroidsmentioning

confidence: 90%

Section: Corticosteroidsmentioning

confidence: 99%

Catecholamine Vasopressor Support Sparing Strategies in Vasodilatory Shock

et al. 2019

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“…cortisone per day, over a longer duration of up to 7 days, reduced time-to-vasopressor withdrawal and in some cases mortality, with a tendency for those with lower cortisol response to cosyntropin to show the most benefit32 . In 2018, two large randomized control studies of hydrocortisone in septic shock were published 34,35. In one study, hydrocortisone 200 mg per day did not reduce 90-day mortality; however, there was improved time to shock resolution, and reduced length of time to discharge from both intensive care and hospital 35.…”

mentioning

confidence: 99%

“…In 2018, two large randomized control studies of hydrocortisone in septic shock were published 34,35. In one study, hydrocortisone 200 mg per day did not reduce 90-day mortality; however, there was improved time to shock resolution, and reduced length of time to discharge from both intensive care and hospital 35. Another study did find reduced mortality and reduced vasopressor use in patients who received hydrocortisone and fludrocortisone 34.…”

mentioning

confidence: 99%

Total and high‐affinity corticosteroid‐binding globulin depletion in septic shock is associated with mortality

Meyer

Nenke

Rankin

et al. 2018

Clinical Endocrinology

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“…and the CORTICUS group, enrolling 300 and 500 patients, respectively. The recently completed ADRENAL trial recruited 3800 patients with septic shock and invasive ventilation from four countries (70% from Australia), and examined the effect of hydrocortisone continuous infusion (200 mg/day in ICU). Hydrocortisone was not found to improve mortality in the entire cohort or in any pre‐specified subgroup.…”

Section: Haemodynamic Organ Supportmentioning

confidence: 99%

Review article: Sepsis in the emergency department – Part 3: Treatment

Williams

Keijzers

Macdonald

et al. 2018

Emerg Medicine Australasia

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Although comprehensive guidelines for treatment of sepsis exist, current research continues to refine and revise several aspects of management. Imperatives for rapid administration of broad-spectrum antibiotics for all patients with sepsis may not be supported by contemporary data. Many patients may be better served by a more judicious approach allowing consideration of investigation results and evidence-based guidelines. Conventional fluid therapy has been challenged with early evidence supporting balanced, restricted fluid and early vasopressor use. Albumin, vasopressin and hydrocortisone have each been shown to support blood pressure and reduce catecholamine requirements but without effect on mortality, and as such should be considered for ED patients with septic shock on a case-by-case basis. Measurement of quality care in sepsis should incorporate quality of blood cultures and guideline-appropriateness of antibiotics, as well as timeliness of therapy. Local audit is an essential and effective means to improve practice. Multicentre consolidation of data through agreed minimum sepsis data sets would provide baseline quality data, required for the design and evaluation of interventions.

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Adjunctive Glucocorticoid Therapy in Patients with Septic Shock

Cited by 722 publications

References 35 publications

Catecholamine Vasopressor Support Sparing Strategies in Vasodilatory Shock

Catecholamine Vasopressor Support Sparing Strategies in Vasodilatory Shock

Total and high‐affinity corticosteroid‐binding globulin depletion in septic shock is associated with mortality

Review article: Sepsis in the emergency department – Part 3: Treatment

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