Corticosteroids in septic shock
Keywords:Sepsis, hydrocortisone, fludrocortisone, Critical illness-related corticosteroid insufficiency
Sepsis remains a major public health issue, associated with significant morbidity and mortality. The pathophysiology of the severest form of sepsis, septic shock is complex and associates an excessive inflammatory response and critical illness related corticosteroid insufficiency. Critical illness related corticosteroid insufficiency and an excessive inflammatory response are both treated by corticosteroids. Corticosteroids probably reduced mortality in septic shock. Additionally, corticosteroids induce favorable hemodynamic responses in septic shock. The administration of low doses of corticosteroids over a short period is associated with limited serious adverse reactions. Low doses of hydrocortisone (200mg/day) should be administered in patients with refractory septic shock, as intermittent boluses over a 7-day period without any progressive weaning. Fludrocortisone should be associated with hydrocortisone. Novel biomarkers are being sought to identify patients with sepsis that could most benefit from corticosteroids.