Corticosteroids for septic shock.

OBJECTIVE To gather the data to provide a rationale for using replacement therapy with hydrocortisone in septic shock patients. DATA SOURCES The Medline and the Cochrane Library databases. STUDY SELECTION Studies in animals and in humans were considered when significant data were available about the mechanisms of action of corticosteroids or about their use in severe sepsis. DATA SUMMARY Corticosteroids were the first anti-inflammatory drugs tested in septic patients. Randomized trials clearly showed that a short course of a large dose of anti-inflammatory steroids is ineffective and potentially harmful in patients with severe sepsis. Recent demonstrations of altered hypothalamic-pituitary-adrenal axis response to septic insult have led to a reappraisal of the use of steroids in septic shock. Randomized trials in catecholamine-dependent septic shock patients strongly suggest that replacement therapy with hydrocortisone may alleviate the symptoms of systemic inflammatory response, reduce the duration of shock, and favorably affect survival. CONCLUSIONS Current evidence that the therapeutic interest of replacement therapy with corticosteroids increases suggests that low doses of hydrocortisone should be offered to patients with catecholamine-dependent septic shock.