Advertisement

Corticosteroids in Sepsis

  • Sergey Goodman
  • Charles L. Sprung
Part of the Perspectives on Critical Care Infectious Diseases book series (CCID, volume 2)

Abstract

The use of corticosteroids in severe sepsis and septic shock has been controversial for decades. The present chapter will review the potential benefits and detriments of the use of corticosteroids in sepsis, the use of corticosteroids in animal models of sepsis and, with particular emphasis, their use in humans with severe sepsis and septic shock.

Keywords

Septic Shock Severe Sepsis Acute Respiratory Distress Syndrome Septic Shock Patient Shock Reversal 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Auphan N. Immunosuppression by glucocorticoids: Inhibition of NF-KB activity through induction of IKB synthesis. Science 1995;270:286–290.PubMedCrossRefGoogle Scholar
  2. 2.
    Chi EY, Henderson, WR, Klebanoff SJ: Phospholipase A2-induced rat mast cell arachidonate metabolites. Lab Invest 1982; 47:579.PubMedGoogle Scholar
  3. 3.
    Carlet J. From mega to more reasonable doses of corticosteroids: A decade to recreate hope. Crit Care Med 1999; 27:672–674.PubMedCrossRefGoogle Scholar
  4. 4.
    Schein RMH, Sprung CL, Marcial EH, Napolitano L, Chernow B. Plasma cortisol levels in patients with septic shock. Crit Care Med 1990;18:259–263.PubMedCrossRefGoogle Scholar
  5. 5.
    Schein RMH, Long WM, Sprung CL. Controversies in management of sepsis and septic shock: Corticosteroids, naloxone, and nonsteroidal anti-inflammatory Agents. In: Sibbald WJ, Sprung CL, (editors). New Horizons — Perspectives on sepsis and septic shock. Fullerton: Society of Critical Care Medicine 1986; 339–368.Google Scholar
  6. 6.
    Melby JC. Systemic corticosteroid therapy: Pharmacology and endocrinologic considerations. Ann Intern Med 1974;81:505–512.PubMedGoogle Scholar
  7. 7.
    Weismann G, Thomas L. Studies on lysosomes. 1. The effect of endotoxin tolerances and cortisone on the release of acid hydrolases from a granular fraction of rabbit liver. J Exp Med 1962;116:433–450.CrossRefGoogle Scholar
  8. 8.
    Jacob HS, Craddock PR, Hammerschmidt DE et al. Complement-induced granulocyte aggregation: an unsuspected mechanism of disease. N Engl J Med 1980;302:780–784.CrossRefGoogle Scholar
  9. 9.
    Kalter ES, Carlson RW, Thijs LG, et al. Effects of methylprednisolone on hemodynamics, arteriovenous oxygen difference, P50 and 2,3 DPG in bacterial shock. Crit Care Med 1982; 10:662–666.PubMedCrossRefGoogle Scholar
  10. 1.
    Vale W, Spiess J, Rivier C, Rivier J. Characterization of a 41 residue ovine hypothalamic peptide that stimulates secretion of corticotropin and β-endorphin. Science 1981;213:1394.PubMedCrossRefGoogle Scholar
  11. 11.
    Barnes P. Beta-adrenergic receptors and their regulation. Am J Resp Crit Care Med 1995;152:838–860.PubMedGoogle Scholar
  12. 12.
    Davis AO, Lefkowitz RJ. Corticosteroid induced differential regulation of _-adrenergic receptors in circulating human polymorphonuclear leukocytes and mononuclear leukocytes. J Clin Endocrinol Metab 1980;51:599–605.CrossRefGoogle Scholar
  13. 13.
    Eidelman LA, Sprung CL. Why have new effective therapies for sepsis not been developed? Crit Care Med 1994; 22:1330–1334.PubMedCrossRefGoogle Scholar
  14. 14.
    Greisman SE. Experimental gram-negative bacterial sepsis: Optimal methylprednisolone requirements for prevention of mortality not preventable by antibiotics alone. Proceed Soc Experiment Biol Med 1982; 170:436–442.Google Scholar
  15. 15.
    Hellman A, Alestig K. High doses of corticosteroids in the treatment of septic shock. Acta Chir Scand Supp 1985;526:124–128.Google Scholar
  16. 16.
    Hinshaw LB, Archer LT, Beller-Todd BK, et al. Survival of primates in lethal septic shock following delayed treatment with steroid. Circ Shock 1981;8:291–300.PubMedGoogle Scholar
  17. 17.
    Hinshaw LB, Beller-Todd BK, Archer LT. Effectiveness of steroid/antibiotic treatment in primates administered LD100 Escherichia coli. Ann Surg 1981;194:51–56.PubMedCrossRefGoogle Scholar
  18. 18.
    Hinshaw LB, Beller-Todd BK, Archer LT. Current management of the septic shock patient: experimental basis for treatment. Circ Shock 1982; 9:543–553.PubMedGoogle Scholar
  19. 19.
    Kass EH, Finland M. Adrenocortical hormones and the management of infection. Ann Rev Med 1957;8:1–18.PubMedCrossRefGoogle Scholar
  20. 20.
    Spink WW. ACTH and adrenocorticosteroids as therapeutic adjuncts in infectious diseases. N Engl J Med 1957;257:979–983.PubMedCrossRefGoogle Scholar
  21. 21.
    Hinshaw L, Peduzzi P, Young E, Sprung C, Shatney C, et al. Effect of high-dose glucocorticoid therapy on mortality in patients with clinical signs of systemic sepsis. N Engl J Med 1987;317:659–665.CrossRefGoogle Scholar
  22. 22.
    Bone RC, Fisher FJ, Clemmer TP, et al. A controlled trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock. N Engl J Med 1987;317:653–658.PubMedCrossRefGoogle Scholar
  23. 23.
    Bollaert PE, Charpentier C, Levy B, Debouverie M, Audibert G, Larcan A. Reversal of late septic shock with supraphysiological doses of hydrocortisone. Crit Care Med 1998;26:645–650.PubMedCrossRefGoogle Scholar
  24. 24.
    Briegel J, Forst H, Haller M, Schelling G, Kilger E, Kuprat G, Hemmer B, Hummel T, Lenhart A, Heyduck M, Stoll C, Peter K. Stress doses of hydrocortisone reverse hyperdynamic septic shock: A prospective randomized, double-blind, single-center study. Crit Care Med 1999;27:723–732.PubMedCrossRefGoogle Scholar
  25. 25.
    Weitzman S, Berger S. Clinical trial design in studies of corticosteroids for bacterial infections. Ann Intern Med 1974;81:36–42.PubMedGoogle Scholar
  26. 26.
    Kreger BE, Craven DE, McCabe WR. Gram-negative bacteremia IV: re-evaluation of clinical features and treatment in 612 patients. Am J Med 1980;68:344–355.PubMedCrossRefGoogle Scholar
  27. 27.
    Schumer W. Steroids in the treatment of clinical septic shock. Ann Surg 1976;184:333–341.PubMedCrossRefGoogle Scholar
  28. 28.
    Hoffman SL, Punjabi NH, Kumulas S, et al. Reduction of mortality in chloramphenicol treated severe typhoid fever by high-dose dexamethasone. N Engl J Med 1984;310:82–88.PubMedCrossRefGoogle Scholar
  29. 29.
    Sprung CL, Caralis PV, Marcial EH, Pierce M, Gelbard MA, Long WM, Duncan RC, Tendier MD, Karpf M. The effects of high-dose corticosteroids in patients with septic shock. N Engl J Med 1984;311:1137–1143.PubMedCrossRefGoogle Scholar
  30. 30.
    Lefering R, Neugebauer EAM. Steroid controversy in sepsis and septic shock: A meta-analysis. Crit Care Med 1995;23:1294–1303.PubMedCrossRefGoogle Scholar
  31. 31.
    Cronin L, Cook DJ, Carlet J, Heyland DK, King D, Math B, Lansang MAD, Fisher CJ. Corticosteroid treatment for sepsis: A critical appraisal and meta-analysis of the literature. Crit Care Med 1995;23:1430–1439.PubMedCrossRefGoogle Scholar
  32. 32.
    Luce JM, Montgomery AB, Marks JD, Turner J, Metz CA, Murray JF. Ineffectiveness of high-dose methylprednisolone in preventing parenchymal lung injury and improving mortality in patients with septic shock. Am Rev Respir Dis 1988;138:62–68.PubMedCrossRefGoogle Scholar
  33. 33.
    Bernard GR, Luce JM, Sprung CL, Rinaldo JE, Tate RM, Sibbald WJ, Kariman K, Higgins S, Bradley R, Metz CA, Harris TR, Brigham K. High-dose corticosteroids in patients with the adult respiratory distress syndrome. N Engl J Med 1987;317:1565–1570.PubMedCrossRefGoogle Scholar
  34. 34.
    Matot I, Sprung CL. Corticosteroids in septic shock: Resurrection of the last rites? Crit Care Med 1998;26:627–630.PubMedCrossRefGoogle Scholar
  35. 35.
    American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee: American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference. Definitions for Sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992; 20:864–874.CrossRefGoogle Scholar
  36. 36.
    Meduri GU, Headley S, Carson S, Umberger R, Kelso T, Tolley E. Prolonged methylprednisolone treatment improves lung function and outcome of unresolving ARDS. A randomized, double-blind, placebo-controlled trial. JAMA 1998;280:159–165.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Sergey Goodman
    • 1
  • Charles L. Sprung
    • 1
  1. 1.Department of Anesthesiology and Critical Care MedicineHadassah Hebrew University Medical CenterJerusalemIsrael

Personalised recommendations