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.
