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Kortikosteroide bei schwerer Sepsis und septischem Schock

Corticosteroids for severe sepsis and septic shock

  • Leitthema
  • Published:
Intensivmedizin und Notfallmedizin

Zusammenfassung

Der Nutzen einer adjunktiven Therapie mit niedrig dosierten Kortikosteroiden bei Patienten mit schwerer Sepsis und septischem Schock wird kontrovers diskutiert. Diese Übersicht informiert über wichtige Funktionen des zentralen Stresshormons Kortisol und stellt das Konzept der relativen Nebennierenrindeninsuffizienz im septischen Schock dem der Kortikosteroidinsuffizienz bei schweren systemischen Inflammationen gegenüber. Es wird die aktuelle Datenlage unter Einbeziehung von neuesten Metaanalysen kritisch evaluiert; hierbei wird auch auf mögliche Nebenwirkungen dieser Therapie eingegangen. Es folgen abschließend evidenzbasierte Therapieempfehlungen für die Applikation von niedrig dosiertem Hydrokortison bei Patienten mit schwerem septischem Schock.

Abstract

The benefit of adjunctive application of low dose corticosteroids in patients with severe sepsis and septic shock is discussed controversially. This summary provides information about the role of the central stress hormone cortisol and contrasts the concept of relative adrenal insufficiency in septic shock with the concept of corticosteroid insufficiency in severe systemic inflammation. Current data and newest meta-analyses are critically evaluated; possible side effects of this therapy are discussed. Finally, evidence-based recommendations for the application of low-dose hydrocortisone in patients with severe septic shock are provided.

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Authors and Affiliations

  1. Universitätsklinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin CCM/CVK, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    D. Keh, S. Niederberger, M. Krebs & O. Ahlers

  2. Klinik für Anästhesiologie, Klinikum der Universität München, München, Deutschland

    J. Briegel

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  1. D. Keh
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  2. J. Briegel
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  3. S. Niederberger
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  4. M. Krebs
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  5. O. Ahlers
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Correspondence to D. Keh.

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Keh, D., Briegel, J., Niederberger, S. et al. Kortikosteroide bei schwerer Sepsis und septischem Schock. Intensivmed 46, 534–540 (2009). https://doi.org/10.1007/s00390-009-0112-6

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  • DOI: https://doi.org/10.1007/s00390-009-0112-6

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