The International Sepsis Forum's controversies in sepsis: corticosteroids should not be routinely used to treat septic shock.
Corticosteroid treatment of severe sepsis has been one of the most controversial clinical issues in critical care. In fact, few agents can claim to have been evaluated in scores of studies spanning 3-4 decades. Yet, convincing proof that corticosteroids are useful pharmacologic agents in the treatment of this major clinical problem remains elusive. Recently, interest has resurfaced but this time the focus is on a steroid replacement approach for what has now been termed "relative adrenal insufficiency" rather than relying on the pharmacologic effects of steroids. This route holds promise, but proof remains lacking.
Bernard
Gordon
G
Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville, Tennessee, USA. Gordon.Bernard@Vanderbilt.edu
D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D016032:Randomized Controlled Trials as Topic; D012772:Shock, Septic / Q000097:blood / Q000188:drug therapy* / Q000401:mortality
D000305:Adrenal Cortex Hormones; D006854:Hydrocortisone