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Clinical Management of Endotoxemia: Corticosteroids

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Endotoxin Induced-Shock: a Multidisciplinary Approach in Critical Care

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Abstract

In the last decades, corticosteroids have been widely used in septic patients despite hundreds of observational studies and randomized clinical trials (RCTs). Controversies are numerous and potentially due to different therapeutic regimens, patient heterogeneity, type of infection, and great “inter-patient” variability of immune responses to infection (i.e., hyper- versus hypo-inflammatory states).

Efficacy and potential risks of corticosteroids in septic patients have not been well assessed. According to the last RCTs, meta-analyses, and updated international guidelines, corticosteroids do not affect short-term and long-term mortality, while they seem to achieve a small reduction in the length of hospital and ICU stay. Corticosteroids are associated with a higher risk of hypernatremia and hyperglycemia, while the effects on superinfection and gastroduodenal bleeding are unclear. Adherence to the current international guidelines for the use of corticosteroids in clinical practice is advisable.

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Author information

Authors and Affiliations

  1. Institute of Anesthesia and Intensive Care, Padua University Hospital, Padua, Italy

    Annalisa Boscolo, Nicolò Sella, Tommaso Pettenuzzo & Paolo Navalesi

  2. Department of Medicine (DIMED), University of Padua, Padua, Italy

    Annalisa Boscolo & Paolo Navalesi

Authors
  1. Annalisa Boscolo
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  2. Nicolò Sella
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  3. Tommaso Pettenuzzo
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  4. Paolo Navalesi
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Editor information

Editors and Affiliations

  1. Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS Trento, Centre for Medical Sciences - CISMed University of Trento, Via S. Maria Maddalena, Trento, Italy

    Silvia De Rosa

  2. Anesthesiology and Intensive Care, Dept. of Health Science, University of Florence, Firenze, Italy

    Gianluca Villa

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Boscolo, A., Sella, N., Pettenuzzo, T., Navalesi, P. (2023). Clinical Management of Endotoxemia: Corticosteroids. In: De Rosa, S., Villa, G. (eds) Endotoxin Induced-Shock: a Multidisciplinary Approach in Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-031-18591-5_8

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  • DOI: https://doi.org/10.1007/978-3-031-18591-5_8

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-18590-8

  • Online ISBN: 978-3-031-18591-5

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