Steroids in Sepsis

Is there a use for steroids in sepsis? The answer depends on whether studies were performed before 1989 or after 1997, according to researchers from the National Institutes of Health and Massachusetts General Hospital.

After evaluating findings from 14 studies, investigators noted that in eight of nine pre-1989 studies, glucocorticoids had no beneficial effects and actually had consistent, harmful effects on patient survival. The post-1997 studies revealed the opposite.

Before 1989, shorter courses of high-dose glucocorticoids were administered earlier in the patients’ septic episodes. After 1997, steroids were given in lower doses, to more severely ill patients, as late as 72 hours after vasopressor agents were initiated, and for a much longer time.
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The researchers noted that they could not definitively identify the optimal dose or timing of steroid therapy. However, on the basis of their analysis of the find­ings, they advise that patients with established vasopressor-dependent septic shock for two to 72 hours might have a better chance of shock reversal and survival if they are given a course of steroids at 200 to 300 mg/day for five to seven days, followed by tapering over five to seven days.