Steroids in sepsis

There has been considerable interest in the use of steroids in sepsis and septic shock from the 1970s. Early clinical trials with short term, high dose steroids showed either no benefit or increased mortality. Current evidence suggests that relative adrenal insufficiency is common in sepsis. This has led to renewed interest in the use of low, physiological doses of corticosteroids in septic shock. Small randomized controlled trials have shown earlier reversal of shock, reduced organ failures and a trend towards reduced mortality. One large trial has shown mortality reduction in a sub group of patients with documented adrenal insufficiency. It would seem appropriate to consider administration of low dose steroids to patients in septic shock who do not respond adequately to initial resuscitative measures and vasopressors.