Corticosteroid Therapy for Septic Shock: Review and Analysis

Abstract

The use of corticosteroids in the treatment of septic shock has been a controversial topic since first investigated. Although early studies were inclusive, a brief analysis of these studies highlights their problems. Examining the effects of pharmacologic corticoids in relation to the clinical syndrome of septic shock provides evidence that corticosteroids improve human survival rate. This evidence is borne out by Schumer's controlled retrospective and prospective double-blind study. Aggressive therapy must begin at the onset of shock; pharmacologic doses of steroids are essential. The three steroids most frequently investigated are methylprednisolone, hydrocortisone, and dexamethasone. To date, a clear advantage of one agent over the other has not been demonstrated clinically, although differences in such effects as leukocyte mobilization and neutrophil function are statistically significant in the laboratory. Recent evidence indicates that methylprednisolone has some advantages over dexamethasone in the treatment of shock lung, however, and further studies are necessary to bridge the gaps between laboratory implications and clinical results.