Corticosteroids in sepsis

“Megadoses” of glucocorticoids were in vogue for sepsis treatment in the 1970s and early 1980s. The practice was abandoned in the late 1980s when studies suggested lack of benefit and possible harm. More recent evidence has suggested benefits of lower pharmacologic doses of hydrocortisone in patients with septic shock. Consequently, hydrocortisone treatment is included in the surviving sepsis guidelines and the sepsis bundle. Part of the rationale for such treatment is the new concept that patients in septic shock have “relative adrenal insufficiency”, a form of decreased adrenal reserve which differs from classic Addison’s disease. Although evidence in favor of corticosteroid treatment for septic shock is accumulating, controversy persists concerning how relative adrenal insufficiency should be defined and how patients should be selected for treatment. Some of the unanswered questions are now being addressed in the CORTICUS trial. It’s all nicely updated in December’s issue of CCJM.