title: [Corticotherapy in severe infectious states].
abstract: Septic shock is one of the leading cause of death in modern countries. Scientists have made huge improvement in the understanding of mechanisms of inflammation, and the sequence of activation of the various pro and anti-inflammatory markers is now well known. By contrary, physicians have failed to improve survival from septic shock, in spite of the development of specific targets of the various points of the cytokine cascade sought to have a key role in host survival to sepsis. Corticosteroids were among the first anti-inflammatory drugs, which have been tested in high quality randomised controlled trials. These trials clearly showed that patients with septic shock are unlikely to benefit from a short course of a large dose of an anti-inflammatory steroid. More recent findings highlighting the role of the integrity of the hypothalamic-pituitary -adrenal axis to appropriately respond to a septic insult, have led to a reappraisal of the use of steroids in septic shock. Several high quality randomised controlled trials have evaluated the efficacy and safety of a prolonged treatment with low dose hydrocortisone in severe sepsis. These trials strongly suggested that this strategy of corticotherapy reduced the morbidity of septic shock and may favourably affect survival from septic shock.
authors.affiliation: Service de réanimation médicale, Hôpital Raymond Poincaré, 104, boulevard Raymond Poincaré, 92380 Garches. djillali.annane@rpc.ap-hop-paris.fr
authors.forename: D
authors.initials: D
authors.lastname: Annane
authors.forename: T
authors.initials: T
authors.lastname: Sharshar
authors.forename: I
authors.initials: I
authors.lastname: Auriant
authors.forename: B
authors.initials: B
authors.lastname: Clair
authors.forename: J C
authors.initials: JC
authors.lastname: Raphael
authors.forename: P
authors.initials: P
authors.lastname: Gajdos
mesh_terms: D000305:Adrenal Cortex Hormones / Q000276:immunology / Q000494:pharmacology / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000276:immunology / Q000494:pharmacology / Q000627:therapeutic use*; D002423:Cause of Death; D003422:Critical Care / Q000379:methods; D016207:Cytokines / Q000187:drug effects / Q000276:immunology; D006801:Humans; D007249:Inflammation; D009017:Morbidity; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D013256:Steroids; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D016207:Cytokines; D013256:Steroids