Do steroids help septic shock

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Do steroids help septic shock?
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• Bob Badgett, 2002-09-06

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Background information
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Background information prior studies
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Cronin, 1995 Meta-analysis
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Annane, 2002
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• RCT of 300 pts
• Severe sepsis
• Ventilated
• Treatment
• hydrocortisone (50 mg q 6 hrs)fludrocortisone
  (50 mcg qd)
• Mortality (steroids vs placebo)
• Overall 55 vs 61
• Adrenal normal 61 vs 53
• Adrenal insufficient 53 vs 63 (p0.02)
• Comments
• First study with sufficient power
• Cotreated with fludrocortisone

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Bollaert, 1998
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• RCT of 41 pts
• Severe sepsis
• Requiring pressors for at least 48 hours
• Treatment
• hydrocortisone 100 mg tid x5d
• Mortality (steroids vs placebo)
• Overall 32 vs 63
• Adrenal normal 33 vs 64
• Adrenal insufficient 25 vs 63 (p0.02)
• Comments
• Small study
• No cotreatment with fludrocortisone

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Evidence Table - summary
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Conclusions

• The combination of a corticosteroids and a
  mineralocorticoid appear to enhance survival in
  patients with severe septic shock who are
  relatively adrenal insufficient.
• Ten such patients must be treated for one to
  benefit.
• In patients with septic shock and a normal
  adrenal gland, steroids may increase mortality.

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Recommendations

• If your hospital can return the results of a
  consytropin test in 1-2 days
• Obtain the test
• Give hydrocortisone (50-mg intravenous bolus
  every 6 hours)
• Fludrocortisone (50- micro g tablet once daily)
• If the cosyntropin test is normal, stop the
  therapy, otherwise, continue for 7 days.
• If your hospital cannot return the test result
  quickly
• Urge your hospital to change their practice
• Until then, do not use corticosteroids.