Early dexamethasone treatment for septic shock patients: a prospective randomized clinical trial.
OBJECTIVE
Sepsis and septic shock are very common conditions among critically ill patients that lead to multiple organ dysfunction syndrome (MODS) and death. Our purpose was to investigate the efficacy of early administration of dexamethasone for patients with septic shock, with the aim of halting the progression towards MODS and death.


METHODS
Prospective, randomized, double-blind, single-center study, developed in a surgical intensive care unit at Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo.


METHODS
The study involved 29 patients with septic shock. All eligible patients were prospectively randomized to receive either a dose of 0.2 mg/kg of dexamethasone (group D) or placebo (group P), given three times at intervals of 36 hours. The patients were monitored over a seven-day period by means of the sequential organ failure assessment score.


RESULTS
Patients treated with dexamethasone did not require vasopressor therapy for as much time over the seven-day period as did the placebo group (p = 0.043). Seven-day mortality was 67% in group P (10 out of 15) and 21% in group D (3 out of 14) (relative risk = 0.31, 95% confidence interval 0.11 to 0.88). Dexamethasone enhanced the effects of vasopressor drugs.


CONCLUSIONS
Early treatment with dexamethasone reduced the seven-day mortality among septic shock patients and showed a trend towards reduction of 28-day mortality.
Cicarelli
Domingos Dias
DD
Department of Surgery, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Porto, Portugal. dcicarelli@uol.com.br
Vieira
Joaquim Edson
JE
Benseñor
Fábio Ely Martins
FE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001938:Brazil / Q000453:epidemiology; D003907:Dexamethasone / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010919:Placebos; D012772:Shock, Septic / Q000188:drug therapy* / Q000401:mortality; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
D000893:Anti-Inflammatory Agents; D010919:Placebos; D014662:Vasoconstrictor Agents; D003907:Dexamethasone