Efficacy of corticosteroids for the treatment of septic shock
Abstract
SUMMARY
The hypothalamic-pituitary-adrenal axis has a great importance in the process of the body’s fight against any infection.
In fact, several studies, including reports of an experts’ conference and those of a consensus conference, reveal a high probability of the alteration of the endocrine response in a context of septic shock.
This alteration might appear as ACTH deficiency (adrenocorticotropic deficiency) which pejorative prognosis is attested even if the pathophysiological mechanisms of this inappropriate endocrine response remain poorly understood.
This inappropriate endocrine response might represent thus a rational which is pertinent enough for the use of corticosteroids in the treatment of the septic shock. This rational is enhanced even more on the one hand by a better understanding of the corticosteroids action mechanisms process. On the other hand, by good proved benefit-risk ratio, of the use of corticosteroids, in a given situation dominated by an uncontrolled systemic inflammatory reaction, such as the septic shock.
According to the results of several studies –animal and clinical – the doses of 200 mg /day of hydrocortisone (or equivalent) might allow to restore in a substantial way the hemodynamic and immunizing homeostasis during the severe sepsis and the septic shock.1
A systematic review of randomized trials shows that a corticosteroid therapy at low-dose (200 to 300mg / day of hydrocortisone or equivalent) administered over a long period (at least 5 days of full dose) would improve the 28-day survival at hospital, it would also increase the probability of the shock resolution, it will decrease the period of stay in the intensive care unit and it wouldn’t cause any serious side effects with the exception of metabolic complications.1
However, to date, despite all these provided elements in current practice, the adoption of corticosteroids treatment in septic shock remains very controversial.
This controversy is widely based on the results of some studies that do not only show the absence of any benefit -linked to the use of corticosteroids – but also the possibility of the prognostic aggravation.
