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Steroids and Septic Shock
- Do low-dose steroids improve mortality or shock reversal in patients with septic shock?
- A recent systematic review published in the Journal of Emergency Medicine found:
- A statistically significant improvement in shock reversal (RR 1.17)
- A favorable, but not statistically significant, mortality benefit for patients with refractory septic shock (RR 0.92; CI 0.79-1.07)
- Most guidelines recommend against steroids for septic patients that are responding to fluid resuscitation and vasopressor therapy.
- Updated guidelines from the Surviving Sepsis Campaign (soon to be published) will continue to recommend low-dose IV corticosteroids (200 mg over 24hrs) for those who are refractory to fluids/vasopressors.
References
Sherwin RL, Garcia AJ, Bilkovski R. Do low-dose corticosteroids improve mortality or shock reversal in patients with septic shock? A systematic review and position statement prepared for the American Academy of Emergency Medicine. JEM 2012;43:7-12.