Glucocorticoids and sepsis.
Although systemic inflammation is the hallmark of sepsis, the use of glucocorticoids remained controversial during many years. Gluco-corticoids exert key actions during sepsis, interacting with metabolism, immune and cardiovascular systems. Glucocorticoid insufficiency is common during sepsis and may result from insufficient production of cortisol or peripheral tissues resistance. Thus, recent randomised trials showed that a replacement therapy with long course of low dose corticosteroids reduced mortality from septic shock. Improvement in survival may result from reduced duration of shock, alleviation of the systemic inflammatory response, and reduction in the number and intensity of organs dysfunction. This article summarises why, when and how glucocorticoids should be used in the management of septic shock.
Allary
J
J
Department of Anesthesiology and Critical Care, Raymond Poincaré Hospital, University of Medicine, Paris Ile de France Ouest, Garches, France.
Annane
D
D
D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003422:Critical Care; D005938:Glucocorticoids / Q000009:adverse effects / Q000502:physiology / Q000627:therapeutic use*; D006801:Humans; D018805:Sepsis / Q000188:drug therapy* / Q000503:physiopathology
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids