Corticosteroids in the Treatment of Severe Sepsis and Septic Shock in Adults

Annane, Djillali; Bellissant, Éric; Bollaert, Pierre Edouard; Briegel, Josef; Confalonieri, Marco; Gaudio, Raffaele De; Keh, Didier; Kupfer, Yizhak; Oppert, Michael; Meduri, G. Umberto

doi:10.1001/jama.2009.815

Cited by 504 publications

(360 citation statements)

References 45 publications

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“…and Sprung et al .,156 faster shock reversal was observed in both studies as a result of administering HC 200 mg/day in four divided doses, although the 28‐day mortality rate was significantly lower in the Annane study than the Sprung study. In a meta‐analysis by Annane et al 171. assessing 17 RCTs, HC administration methods were divided into four according to the high‐dose/low‐dose (with a 300 mg/day limit) and long‐term/short‐term (with a 5‐day limit) and examined.…”

Section: Cq8: Corticosteroid Therapy For Septic Shockmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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Background and PurposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two‐thirds (>66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J‐SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta‐analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese‐specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non‐specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

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Section: Cq8: Corticosteroid Therapy For Septic Shockmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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“…This condition has been termed critical illnessrelated corticosteroid insufficiency (CIRCI) [5,6]. The presence of CIRCI may increase the morbidity and mortality of critically ill patients and predispose to PTSD [6][7][8][9].…”

mentioning

confidence: 99%

The “koala stress syndrome” and adrenal responsiveness in the critically ill

Marik

Levitov

2010

Intensive Care Med

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“…Additionally, Annane et al performed a systematic review on the benefits of corticosteroids in the treatment of severe sepsis and septic shock in adults. A favorable effect of treatment on shock reversal at 7 and 28 days was shown [5]. Indeed, shock reversal (as defined by a stable hemodynamic status for [24 h after withdrawal of vasopressor therapy) at 7 days for treated patients was 308 of 485 (63.5 %) versus 226 of 480 (47.1 %) (RR, 1.35; 95 % CI, 1.16-1.57; p \ 0.001) in the control group.…”

mentioning

confidence: 85%

Adverse cardiac events during catecholamine therapy: a role for hydrocortisone?

et al. 2012

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Dear Editor, We read with great interest the study by Schmittinger et al. [1] hypothesizing that adverse cardiac events frequently occur during catecholamine vasopressor therapy and that catecholamine vasopressor support is associated with both morbidity and mortality. In this prospective observational study, 54 of 112 surgical intensive care unit patients with cardiovascular failure developed a total of 114 adverse cardiac events during catecholamine vasopressor therapy, an incidence of 48.2 % (95 % CI, 38.8-57.6 %). The two adverse cardiac events most frequently observed in this study were tachyarrhythmia and prolonged elevated heart rate, both of which were correlated with significant morbidity and mortality. Sepsis was observed in a total of 44 (39 %) patients. In the Patients and Methods section, the authors detailed that ''hydrocortisone (200-300 mg/ day) was added as a continuous infusion if escalating norepinephrine dose could not stabilize hemodynamic function.'' Unfortunately, we did not find any details about the dose, the duration and the weaning for hydrocortisone therapy in the results or in the discussion sections. There is still an ongoing debate about hydrocortisone therapy during septic shock: the CORTICUS study conducted by Sprung et al. [2] did not find a significant reduction in mortality in the hydrocortisone group, but Moreno et al.[3] observed a significant reduction of SOFA scores mainly represented by a faster decrease in the cardiovascular component. The hydrocortisone-treated group had a higher mean number of vasopressor-free days in the first 7 days (2.5 ± 2.4) compared with the placebo group (1.4 ± 2.4) (p \ 0.0001).

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Corticosteroids in the Treatment of Severe Sepsis and Septic Shock in Adults

Cited by 504 publications

References 45 publications

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

The “koala stress syndrome” and adrenal responsiveness in the critically ill

Adverse cardiac events during catecholamine therapy: a role for hydrocortisone?

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