Steroids and Septic Shock

• Do low-dose steroids improve mortality or shock reversal in patients with septic shock?
• A recent systematic review published in the Journal of Emergency Medicine found:
  • A statistically significant improvement in shock reversal (RR 1.17)
  • A favorable, but not statistically significant, mortality benefit for patients with refractory septic shock (RR 0.92; CI 0.79-1.07)
• Most guidelines recommend against steroids for septic patients that are responding to fluid resuscitation and vasopressor therapy.
• Updated guidelines from the Surviving Sepsis Campaign (soon to be published) will continue to recommend low-dose IV corticosteroids (200 mg over 24hrs) for those who are refractory to fluids/vasopressors.

References

Sherwin RL, Garcia AJ, Bilkovski R. Do low-dose corticosteroids improve mortality or shock reversal in patients with septic shock? A systematic review and position statement prepared for the American Academy of Emergency Medicine. JEM 2012;43:7-12.