Effect of low doses of corticosteroids in septic shock patients with or without early ARDS Annane, Djillali MD, PhD; Sebille, Veronique PhD; Bellissant, Eric MD, PhD; for the Ger-Inf-05 Study Group

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Effect of low doses of corticosteroids in septic
shock patients with or without early ARDSAnnane,
Djillali MD, PhD Sebille, Veronique PhD
Bellissant, Eric MD, PhD for the Ger-Inf-05
Study Group
Crit Care Med 2006 Vol. 34 No. 1 22-30

• Presented by Ri???/VS???

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ARDS

• A life threatening condition
• 1726/100000/year in US
• Mortality rate remains about 4050
• Survivor may have persistent pulmonary and/or
  nonpulmonary disability
• Excessive and protracted systemic inflammation

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Mechanism
Inflammatory signal
Steroid
NF-?B
CR a
DNA
DNA
Inflammation
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Objective and Methods

• The efficacy and safety of low doses of
  corticosteroid in septic shock-associated early
  ARDS
• Retrospective analysis
• Multiple-center, placebo-controlled, randomized,
  double-blind study

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methods

• Responder and non-responder
• Corticotropin test with tetracosactrin
• Cortisol increase 9 µg/dL
• Intervention
• Hydrocortisone 50mg Q6H 9-a-fludrocortisone
  50µg QD for 7 days

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Result
Crit Care Med 2006 Vol. 34 No. 1 22-30
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Result
Crit Care Med 2006 Vol. 34 No. 1 22-30
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Discussion

• In ARDS non-responder
• significantly improved survival at day 28 and at
  ICU and hospital discharge
• reduced the duration of mechanical ventilation
• In ARDS responder
• no evidence for beneficial or deleterious effect
• Only moderately favorable effects observed in the
  whole population

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Result
IL-6 Circulating Level v.s. Time
Non-responder Responder
All ARDS
Crit Care Med 2006 Vol. 34 No. 1 22-30
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Discussion

• IL-6, a marker of systemic inflammation
• IL-6 circulating leves at baseline were clearly
  higher in nonresponders than in reponders
• A higher degree of systemic inflammation
• Explaining the greater effect of the steroid
  therapy

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Result and discussion

• No obvious difference in the septic shock without
  ARDS
• The benefit from corticosteroid observed in
  septic shock associated ARDS was mainly related
  to the treatment of ARDS and not to the treatment
  of septic shock ?
• Limited sample size ?

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Conclusion

• A 7-day treatment with low doses of
  corticosteroid was associated with better
  outcomes in septic shock-associated early ARDS
  nonresponders but not in responders, and not in
  septic shock patients without ARDS

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Thank you for your attention