Corticosteroid therapy for sepsis: a clinical practice guideline

Lamontagne, François; Rochwerg, Bram; Lytvyn, Lyubov; Guyatt, Gordon; Møller, Morten Hylander; Annane, Djillali; Kho, Michelle E.; Adhikari, Neill K. J.; Machado, Flávia Ribeiro; Vandvik, Per Olav; Dodek, Peter; Leboeuf, Rébecca; Briel, Matthias; Hashmi, Madiha; Camsooksai, Julie; Shankar-Hari, Manu; Baraki, Mahder Kinfe; Fugate, Karie; Chua, S.; Marti, Christophe; Cohen, Dian; Botton, Edouard; Agoritsas, Thomas; Siemieniuk, Reed A C

doi:10.1136/bmj.k3284

Cited by 102 publications

(97 citation statements)

References 32 publications

(37 reference statements)

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“…A recent meta-analysis of 42 RCTs including 9969 adults and 225 children with sepsis found that corticosteroids possibly result in a small reduction in short-term mortality (RR, 0.93; 95% CI, 0.84-1.03), long-term mortality (0.94; 95% CI, 0.89-1.00), faster resolution of shock, and shorter LOS, while also possibly increasing the risk of neuromuscular weakness (RR, 1.21; 95% CI, 1.01-1.52) [327]. Despite a weak recommendation to treat sepsis with hydrocortisone based on the findings noted in the overall meta-analysis [328], the pediatric studies enrolled a combined small number of subjects, reported inconsistent conclusions, had methodologic limitations, and did not demonstrate an overall mortality reduction [320,[329][330][331] (Supplemental Table 19, Supplemental Digital Content 1, http:// links .lww.com/PCC/B139).…”

Section: Corticosteroidsmentioning

confidence: 98%

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

et al. 2020

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Objectives: To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction.Design: A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those The Society of Critical Care Medicine guidelines are intended for general information only, are not medical advice, and do not replace professional advice, which should be sought for any medical condition. The full disclaimer for guidelines can be accessed at https ://www.sccm.org/Resea rch/Guide lines /Guide lines . panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process. Methods:The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, "in our practice" statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. Results:The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 49 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, "in our practice" statements were provided. In addition, 52 research priorities were identified. Conclusions:A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research. S14 the group heads, panel members, and methodologists. Searches utilized ...

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Section: Corticosteroidsmentioning

confidence: 98%

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

et al. 2020

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“…As a potent anti-inflammatory and anti-fibrotic drug, low doses of methylprednisolone (DEPO-Medrol or SOLU-Medrol) have the potential to prevent an extended cytokine response and may accelerate resolution of pulmonary and systemic inflammation in pneumonia [83,84]. Recently, many medical researchers believe that corticosteroids, especially methylprednisolone, may improve dysregulated immune response caused by sepsis (possible complication of infection with COVID-19) and increase blood pressure when it is low [85]. Specifically, in a retrospective cohort study, 201 patients with confirmed COVID-19 who developed ARDS were treated with methylprednisolone (1-2 mg/kg daily IV for 5-7 days) and the results showed that treatment with methylprednisolone may be beneficial for patients who develop ARDS in the reduction of the risk of death.…”

Section: Corticosteroidsmentioning

confidence: 99%

An Update on Current Therapeutic Drugs Treating COVID-19

et al. 2020

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The current pandemic of coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has presented unprecedented challenges to the healthcare systems in almost every country around the world. Currently, there are no proven effective vaccines or therapeutic agents against the virus. Current clinical management includes infection prevention and control measures and supportive care including supplemental oxygen and mechanical ventilatory support. Evolving research and clinical data regarding the virologic SARS-CoV-2 suggest a potential list of repurposed drugs with appropriate pharmacological effects and therapeutic efficacies in treating COVID-19 patients. In this review, we will update and summarize the most common and plausible drugs for the treatment of COVID-19 patients. These drugs and therapeutic agents include antiviral agents (remdesivir, hydroxychloroquine, chloroquine, lopinavir, umifenovir, favipiravir, and oseltamivir), and supporting agents (Ascorbic acid, Azithromycin, Corticosteroids, Nitric oxide, IL-6 antagonists), among others. We hope that this review will provide useful and most updated therapeutic drugs to prevent, control, and treat COVID-19 patients until the approval of vaccines and specific drugs targeting SARS-CoV-2.

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“…The most debating question is the possible usage of GCs during COVID-19 pandemic and, in case, which, at which disease stage, and at which dosage/administration route. Hydrocortisone showed to improve respiratory and mortality outcome in bacterial severe community-acquired pneumonia [34] and inconstant efficacy in septic shock [35,36]. Budesinide might reduce post viralinflammatory-cytokine production by human bronchial epithelial cells in vitro [37], while discordant results are reported in viral influenza pneumonia.…”

Section: Glucocorticoidsmentioning

confidence: 99%