Corticosteroids for septic shock.
OBJECTIVE
To gather the data to provide a rationale for using replacement therapy with hydrocortisone in septic shock patients.


METHODS
The Medline and the Cochrane Library databases.


METHODS
Studies in animals and in humans were considered when significant data were available about the mechanisms of action of corticosteroids or about their use in severe sepsis.


METHODS
Corticosteroids were the first anti-inflammatory drugs tested in septic patients. Randomized trials clearly showed that a short course of a large dose of anti-inflammatory steroids is ineffective and potentially harmful in patients with severe sepsis. Recent demonstrations of altered hypothalamic-pituitary-adrenal axis response to septic insult have led to a reappraisal of the use of steroids in septic shock. Randomized trials in catecholamine-dependent septic shock patients strongly suggest that replacement therapy with hydrocortisone may alleviate the symptoms of systemic inflammatory response, reduce the duration of shock, and favorably affect survival.


CONCLUSIONS
Current evidence that the therapeutic interest of replacement therapy with corticosteroids increases suggests that low doses of hydrocortisone should be offered to patients with catecholamine-dependent septic shock.
Annane
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Service de Réanimation Médicale, Hôpital Raymond Poincaré, Faculté de Médecine Paris-Ouest, University Paris V, Garches, France. djillali.annane@rpc.ap-hop-paris.fr
D000309:Adrenal Insufficiency / Q000382:microbiology; D000818:Animals; D000893:Anti-Inflammatory Agents / Q000276:immunology / Q000494:pharmacology / Q000627:therapeutic use*; D004195:Disease Models, Animal; D004353:Drug Evaluation, Preclinical; D006801:Humans; D006854:Hydrocortisone / Q000276:immunology / Q000494:pharmacology / Q000627:therapeutic use*; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects / Q000503:physiopathology; D007249:Inflammation; D010913:Pituitary-Adrenal System / Q000187:drug effects / Q000503:physiopathology; D012772:Shock, Septic / Q000150:complications / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality / Q000503:physiopathology; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone