High-dose corticosteroid therapy in human septic shock: has the jury reached a correct verdict?
Many studies have been published concerning high-dose corticosteroids (HDC) in septic shock. Most of them have been criticized for not adhering to methodologic standards. Four studies were published during the 1980s taking into consideration the criticism of previous trials. The general conclusion following these trials was the HDC should not be used in the treatment of septic shock. The aim of this review is to compare these trials as regards their aims, study design, results, and conclusions. The validity of the data presented is discussed. It is concluded that there is no unequivocal evidence that HDC is beneficial in septic shock, but it must be realized that there are tremendous difficulties in obtaining the true state of affairs in clinical trials regarding patients in septic shock. Accumulated data indicate that HDC, given as one single dose during the initial hours of gram-negative septic shock, more likely than not has a beneficial effect on mortality.
Sjölin
J
J
Department of Infectious Diseases, University Hospital, Uppsala, Sweden.
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D006801:Humans; D012307:Risk Factors; D012772:Shock, Septic / Q000188:drug therapy*
D000305:Adrenal Cortex Hormones