Cortisol replacement for severe sepsis and septic shock: what should I do?
Based on several recently completed randomized controlled trials, cortisol replacement is likely to become a standard of care for vasopressor dependent septic shock. Further studies are needed in order to accomplish whether this treatment should be limited to patients with a blunted cortisol response to corticotrophin. Similarly, in patients with severe sepsis who do not need vasopressors, the benefit/risk ratio of cortisol replacement remains to be assessed.
Intensive Care Department, Raymond Poincaré University Hospital, Garches, France. djillali.annane@rpc.ap-hop-paris.fr
Djillali
D
Annane
D000309:Adrenal Insufficiency / Q000209:etiology; D000324:Adrenocorticotropic Hormone; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D018805:Sepsis / Q000150:complications / Q000188:drug therapy*; D012772:Shock, Septic / Q000188:drug therapy*; D014666:Vasomotor System / Q000187:drug effects
D000893:Anti-Inflammatory Agents; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone