Abstract
Background
Severe sepsis and septic shock are potentially deadly conditions managed in the emergency
department (ED). Management centers on source control, fluid resuscitation, broad-spectrum
antimicrobials, and vasopressors as needed. The use of corticosteroids is controversial.
Objective
To evaluate the evidence behind corticosteroid therapy in patients with septic shock.
Discussion
Septic shock is associated with severe mortality and morbidity. Cytokine release produces
a systemic inflammatory state. Vasopressor-resistant septic shock warrants consideration
of the disease state and other pathologies such as adrenal insufficiency. Many studies
and meta-analyses have been conducted evaluating corticosteroid therapy for this population.
High-dose corticosteroid therapy is associated with increased harm, but physiologic-dose
corticosteroids may decrease the need for vasopressors. Mortality benefit is controversial,
with much of the literature demonstrating no effect. The risk of superinfection is
not suggested by the majority of studies. The Surviving Sepsis Campaign advises consideration
of corticosteroids in patients with vasopressor and fluid-resistant septic shock.
Patients with vasopressor-resistant septic shock with no contraindications to corticosteroids
may benefit from hydrocortisone 100 mg intravenously (i.v.) every 8 h or 50 mg i.v.
every 6 h. Fludrocortisone is not recommended at this time.
Conclusions
Septic shock is associated with higher mortality, specifically for patients with vasopressor
and fluid-refractory shock. The use of physiologic-dose steroids can reduce vasopressor
requirements and improve time of shock resolution. Current literature suggests corticosteroids
do not improve mortality, but further studies are required.
Keywords
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Article info
Publication history
Published online: September 12, 2017
Accepted:
May 30,
2017
Received in revised form:
April 6,
2017
Received:
August 20,
2016
Identification
Copyright
Published by Elsevier Inc.
