Corticosteroids for Septic Shock
Authors: Peter C. Minneci, Katherine J. Deans, Steven M. Banks, Peter Q. Eichacker, Charles Natanson
Journal: Annals of Internal Medicine (2004)

Letters2 November 2004Corticosteroids for Septic ShockPeter C. Minneci, MD, Katherine J. Deans, MD, Steven M. Banks, PhD, Peter Q. Eichacker, MD, and Charles Natanson, MDPeter C. Minneci, MDFrom National Institutes of Health, Bethesda, MD 20892., Katherine J. Deans, MDFrom National Institutes of Health, Bethesda, MD 20892., Steven M. Banks, PhDFrom National Institutes of Health, Bethesda, MD 20892., Peter Q. Eichacker, MDFrom National Institutes of Health, Bethesda, MD 20892., and Charles Natanson, MDFrom National Institutes of Health, Bethesda, MD 20892.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-9-200411020-00032 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The editorial by Dr. Luce (1) accompanying our meta-analysis examining clinical trials of low-dose steroid therapy in sepsis (2) raised concerns about our recommendation to administer low-dose glucocorticoids to all patients with vasopressor-dependent septic shock. Dr. Luce concluded that the results of the clinical sepsis trials of low-dose steroids support administering steroids only to patients with "proven adrenal insufficiency" (1). As cited by Dr. Luce, a recent report by Hamrahian and colleagues (3) demonstrated that in critically ill patients, variations in total serum cortisol measurements may be explained by differences in the concentration of serum binding proteins, ...References1. Luce JM. Physicians should administer low-dose corticosteroids selectively to septic patients until an ongoing trial is completed [Editorial]. Ann Intern Med. 2004;141:70-2. [PMID: 15238374] LinkGoogle Scholar2. Minneci PC, Deans KJ, Banks SM, Eichacker PQ, Natanson C. Meta-analysis: the effect of steroids on survival and shock during sepsis depends on the dose. Ann Intern Med. 2004;141:47-56. [PMID: 15238370] LinkGoogle Scholar3. Hamrahian AH, Oseni TS, Arafah BM. Measurements of serum free cortisol in critically ill patients. N Engl J Med. 2004;350:1629-38. [PMID: 15084695] CrossrefMedlineGoogle Scholar4. Annane D, Sebille V, Charpentier C, Bollaert PE, Francois B, Korach JM, et al . Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA. 2002;288:862-71. [PMID: 12186604] CrossrefMedlineGoogle Scholar5. Bollaert PE, Charpentier C, Levy B, Debouverie M, Audibert G, Larcan A. Reversal of late septic shock with supraphysiologic doses of hydrocortisone. Crit Care Med. 1998;26:645-50. [PMID: 9559600] CrossrefMedlineGoogle Scholar6. Briegel J, Forst H, Haller M, Schelling G, Kilger E, Kuprat G, et al . Stress doses of hydrocortisone reverse hyperdynamic septic shock: a prospective, randomized, double-blind, single-center study. Crit Care Med. 1999;27:723-32. [PMID: 10321661] CrossrefMedlineGoogle Scholar7. Chawla K, Kupfer Y, Goldman I. Hydrocortisone reverses refractory septic shock [Abstract]. Crit Care Med. 1999;27 1 Suppl A33. CrossrefGoogle Scholar8. Yildiz O, Doganay M, Aygen B, Guven M, Keleutimur F, Tutuu A. Physiological-dose steroid therapy in sepsis [ISRCTN36253388]. Crit Care. 2002;6:251-9. [PMID: 12133187] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From National Institutes of Health, Bethesda, MD 20892. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMeta-Analysis: The Effect of Steroids on Survival and Shock during Sepsis Depends on the Dose Peter C. Minneci , Katherine J. Deans , Steven M. Banks , Peter Q. Eichacker , and Charles Natanson Physicians Should Administer Low-Dose Corticosteroids Selectively to Septic Patients until an Ongoing Trial Is Completed John M. Luce Metrics Cited ByPerioperative Corticosteroid Management for Patients with Inflammatory Bowel DiseaseThe Potential Contribution of Corticosteroids to Positive Cardiac Arrest OutcomesSepsis in the elderlyPart 9: Post–Cardiac Arrest CareSepsis"Relative" adRenal insufficiency in cRitical illnessRelative adrenal insufficiency in post-cardiac arrest shock is under-recognizedMortality and length-of-stay outcomes, 1993–2003, in the binational Australian and New Zealand intensive care adult patient database*Should we use glucocorticoids for severe community-acquired pneumonia?Hypothalamic Pituitary Adrenal Function during Critical Illness: Limitations of Current Assessment MethodsEvidence-based sepsis therapy: A hospitalist perspective 2 November 2004Volume 141, Issue 9Page: 742-743KeywordsAdrenocorticotropic hormoneClinical trialsCortisolSafetySafety studiesSepsisSerum proteinsShockSteroid therapySurvival analysis ePublished: 2 November 2004 Issue Published: 2 November 2004 CopyrightCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...