Do you consider administering iv steroid treatment in the case of severe septic shock?
Actually, I was dubious about the effectiveness of steroid treatment in the case of severe bacterial infection. Recently, I experienced a case of Waterhouse–Friderichsen syndrome. Autopsy uncovered this condition, but I had no idea about adrenal insufficiency. It is tough to estimate the adrenal function in patients with severe septic shock resulting from any bacterial infection. However, I learned, through the recent experience, the importance of considering immediate administration of steroid treatment before the adrenal function being revealed by laboratory examination.
If anyone has ever considered this question or get interested in this question, could you give me suggestion for me?
When the adrenal insuficiency is suspected iv steroids should be given together with the antibiotics. There are two clinical trials using also iv melatonin ( 100 -200 mg) together with antibiotics with very good results in children with septic shok
The current reccomendation is to treat patients with refractory septic shock with Hydrocortisone 50mg q6h or 200mg/24h continuously. Refractory shock is not well defined: it is based on Annane's landmark study on corticosteroids in septic shock which showed a mortality benefit- they defined it as persistent shock refractory to vasopressors for 1 hour. Subsequently, the Corticus study did not find benefit to corticosteroid administration in terms of mortality, but patients who responded to steroids, reversed their shock faster. They found no benefit to ACTH stimulation tests in this population, measurement of which was previously the recommendation. These patients were not as sick as Annane's patients. Personally, if a patient is requiring high dose pressors, or more than one pressor, I consider it refractory, and I add steroids. If you want to grab a cortisol level prior to treatment, I do that, but its not required. Note that even in the CORTICUS study there was no harm to patients receiving steroids.
Thanks for kind replies, Mr.Kuan, Mr.Jesus, and Mr.Jeffrey!
I don't have the blood cortisol levels just because I was unaware of adrenal function and the day when I saw the patient was a holiday.
After reading your comments, it became clear what I should do when I see patients with septic shock.
I appreciate your kind cooperation and helping me with finding informative articles. I think your comments helped me for further study.
Sincerely,
N. Takeuchi
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