Low-dose hydrocortisone improves shock reversal and reduces cytokine levels in early hyperdynamic septic shock*

Oppert, Michael; Schindler, Ralf; Husung, Claudia; Offermann, Katrin; Gräf, K.-J.; Boenisch, Olaf; Barckow, D.; Frei, Ulrich; Eckardt, Kai‐Uwe

doi:10.1097/01.ccm.0000186370.78639.23

Cited by 284 publications

(246 citation statements)

References 35 publications

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“…Three RCTs used a fixed-duration protocol for treatment [300,302,306], and therapy was decreased after shock resolution in two RCTs [301,310]. In four studies, steroids were tapered over several days [300][301][302]310] and steroids were withdrawn abruptly in two RCTs [306,311]. One crossover study showed hemodynamic and immunologic rebound effects after abrupt cessation of corticosteroids [312].…”

Section: H Corticosteroidsmentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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Objective: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". Design:A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. Methods:The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.

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Section: H Corticosteroidsmentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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“…We searched for references published in 2004 or later, when the standardized care for sepsis was introduced by SSCG 2004 after being defined in 1992 as a systemic inflammatory response syndrome (SIRS) accompanying infection, with the keywords “septic shock” and “low‐dose steroid,” and identified eight RCTs (Bollaert et al .,162 Briegel et al .,163 Chawla et al .,164 Annane et al .,165 Oppert et al .,166 Mussack et al .,167 Sprung et al .,156 and Arabi168). As these eight studies were all included in the meta‐analysis by Wang et al .,160 we initially decided to use it for this CQ.…”

Section: Cq8: Corticosteroid Therapy For Septic Shockmentioning

confidence: 99%

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

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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“…Oppert et al 21 performed a singlecenter randomized controlled trial of patients with septic shock to investigate the effects of LDC on shock reversal and changes in the cytokine profile. The results complement the findings of earlier investigators who postulated that the benefit of LDC is related to impaired endogenous adrenal function in sepsis.…”

Section: Oppert and Colleagues 2005mentioning

confidence: 99%

“…(Critical Care Nurse. 2011;31 [6]: [16][17][18][19][20][21][22][23][24][25][26] with methylprednisolone 30 mg/kg or dexamethasone 3 to 6 mg/kg in divided doses were thought to be beneficial because of the profound anti-inflammatory effect. 8 A landmark multicentered randomized trial 6 of HDC therapy in 381 patients with sepsis was performed in 1987.…”

mentioning

confidence: 99%

Low-Dose Corticosteroids to Treat Septic Shock: A Critical Literature Review

Yarema

Yost

2011

Critical Care Nurse

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Septic shock is the 13th leading cause of death in the United States. The rate of severe sepsis nearly doubled and mortality increased more than 60% during the 10-year period ending in 2003. Systemic inflammatory response syndrome has noninfectious and infectious causes. Noninfectious ones include burns, trauma, severe pancreatitis, and therapy with monoclonal antibodies or immunomodulatory drugs such as interleukin 2. Progression from sepsis syndrome to septic shock is caused by a series of immune responses. As an infectious injury progresses, host activation of the coagulation, immunological, and stress response systems ensues, resulting in tissue hypoperfusion and organ failure. Early studies with small numbers of patients suggest that treatment with low-dose corticosteroids has marked beneficial effects on shock reversal, the immune system, and the hemodynamic profile. Low-dose corticosteroids should only be administered to a subset of patients with septic shock who are unresponsive to fluid replacement and vasopressor therapy.

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Low-dose hydrocortisone improves shock reversal and reduces cytokine levels in early hyperdynamic septic shock*

Cited by 284 publications

References 35 publications

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

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

Low-Dose Corticosteroids to Treat Septic Shock: A Critical Literature Review

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