Corticosteroids in sepsis: from bench to bedside?
The use of corticosteroids in patients with septic shock has been recently revisited and the use of low dose corticosteroids led to very promising results, particularly in patients with corticosteroid insufficiency. We review the different mechanisms that can account for their beneficial effects in patients. Glucocorticoids display a wide spectrum of anti-inflammatory properties that have been identified in in vitro and in vivo experimental models (e.g., inhibition of production of pro-inflammatory cytokines, free radicals, prostaglandins and inhibition of chemotaxis, and adhesion molecule expressions.) In addition, glucocorticoids have profound effects on the cardiovascular system (e.g., increasing mean blood pressure, increasing pressor sensitivity, and therefore decreasing the duration of use of catecholamines during septic shock.) Through these anti-inflammatory and cardiovascular effects, low doses of glucorticoids may improve septic shock survival.
Annane
Djillali
D
Raymond Poincaré Hospital, School of Medicine Paris Ile de France Ouest, University of Versailles Saint Quentin en Yvelinnes, 92380 Garches, France. djillali.annane@roc.ap-hop-paris.fr
Cavaillon
Jean-Marc
JM
D000305:Adrenal Cortex Hormones / Q000172:deficiency* / Q000627:therapeutic use*; D000818:Animals; D017209:Apoptosis; D002319:Cardiovascular System / Q000187:drug effects; D016207:Cytokines / Q000378:metabolism; D005609:Free Radicals / Q000378:metabolism; D006801:Humans; D007249:Inflammation; D008263:Macrophage Migration-Inhibitory Factors / Q000378:metabolism; D008954:Models, Biological; D018805:Sepsis / Q000188:drug therapy*; D012769:Shock / Q000188:drug therapy; D014662:Vasoconstrictor Agents / Q000494:pharmacology
D000305:Adrenal Cortex Hormones; D016207:Cytokines; D005609:Free Radicals; D008263:Macrophage Migration-Inhibitory Factors; D014662:Vasoconstrictor Agents