Do pediatric patients with septic shock benefit from steroid therapy? A critical appraisal of "Low-dose hydrocortisone improves shock reversal and reduces cytokine levels in early hyperdynamic septic shock" by Oppert et al. (Crit Care Med 2005; 33:2457-2464).
OBJECTIVE
To review the findings and discuss the implications of studies on the use of low-dose corticosteroids in septic shock.


METHODS
A critical appraisal of "Low-dose hydrocortisone improves shock reversal and reduces cytokine levels in early hyperdynamic septic shock" by Oppert et al. (Crit Care Med 2005; 33:2457-2464) with literature review.


RESULTS
Previous studies have shown that low-dose corticosteroids shorten duration of shock in adults with sepsis, which is confirmed by the results of Oppert et al. The benefit on mortality is much less clear. Review of the literature casts doubt on whether these data can be extrapolated to children.


CONCLUSIONS
There is some, albeit limited, evidence for the benefit of low-dose steroids in adults with sepsis. No supporting data are available for the pediatric population; therefore, a randomized controlled trial in septic children is needed.
van Schaik
Sandrijn M
SM
Division of Pediatric Critical Care Medicine, University of California at San Francisco, San Francisco, CA 94143-0106, USA. vanschaiks@peds.ucsf.edu