Corticosteroids in septic shock: What should the decision in pediatrics be?

Darmaros, Laura Fonseca; Delgado, Artur Figueiredo; Carvalho, Werther Brunow de

doi:10.1590/1806-9282.62.06.482

Cited by 4 publications

(3 citation statements)

References 31 publications

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“…Current management guidelines for pediatric sepsis largely focus on supportive care, including fluid resuscitation and vasoactive medications, in addition to early empiric antibiotics [4]. Hydrocortisone is frequently prescribed as an adjunctive treatment for children with septic shock who have known adrenal insufficiency, those with a history of recent corticosteroid use, and those who remain hemodynamically unstable despite fluid resuscitation and initiation of vasoactive support [5,6]. The use of hydrocortisone in septic shock, however, remains controversial, with clinical trials in adults yielding conflicting results [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Hydrocortisone treatment is associated with a longer duration of MODS in pediatric patients with severe sepsis and immunoparalysis

et al. 2020

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Background: Severe critical illness-induced immune suppression, termed immunoparalysis, is associated with longer duration of organ dysfunction in septic children. mRNA studies have suggested differential benefit of hydrocortisone in septic children based on their immune phenotype, but this has not been shown using a functional readout of the immune response. This study represents a secondary analysis of a prospectively conducted immunophenotyping study of pediatric severe sepsis to test the hypothesis that hydrocortisone will be differentially associated with clinical outcomes in children with or without immunoparalysis. Methods: Children with severe sepsis/septic shock underwent blood sampling within 48 h of sepsis onset. Immune function was measured by quantifying whole blood ex vivo LPS-induced TNFα production capacity, with a TNFα response < 200 pg/ml being diagnostic of immunoparalysis. The primary outcome measure was number of days in 14 with MODS. Univariate and multivariable negative binomial regression models were used to examine associations between hydrocortisone use, immune function, and duration of MODS. Results: One hundred two children were enrolled (age 75 [6-160] months, 60% male). Thirty-one subjects received hydrocortisone and were more likely to be older (106 [52-184] vs 38 [3-153] months, p = 0.04), to have baseline immunocompromise (32 vs 8%, p = 0.006), to have higher PRISM III (13 [8-18] vs 7 [5-13], p = 0.0003) and vasoactive inotrope scores (20 [10-35] vs 10 [3-15], p = 0.0002) scores, and to have more MODS days (3 [1-9] vs 1 [0-3], p = 0.002). Thirty-three subjects had immunoparalysis (TNFα response 78 [52-141] vs 641 [418-1047] pg/ml, p < 0.0001). Hydrocortisone use was associated with longer duration of MODS in children with immunoparalysis after adjusting for covariables (aRR 3.7 [1.8-7.9], p = 0.0006) whereas no association with MODS duration was seen in children without immunoparalysis (aRR 1.2 [0.6-2.3], p = 0.67).

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Section: Introductionmentioning

confidence: 99%

Hydrocortisone treatment is associated with a longer duration of MODS in pediatric patients with severe sepsis and immunoparalysis

et al. 2020

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“…Também foram apresentados estudos com desfechos inconclusivos do uso auxiliar dos corticosteroides no choque séptico (Allen et al, 2019;Angurana & Kumar, 2017;Argent & Kissoon, 2017;Bentzer, Fjell, Walley, Boyd, & Russell, 2016;Briegel, Bein, & Mohnle, 2017;Darmaros, Delgado, & Carvalho, 2016;Hyvernat et al, 2017;Ismail & Jayashree, 2018;Long & April, 2018;O'Hearn et al, 2016;Ramanan, Cohen, & Venkatesh, 2019;Russell & Sevransky, 2019;Zimmerman, 2016).…”

Section: Gráfico 1 Anos De Publicação Dos Artigosmentioning

confidence: 99%

Eficácia Do Uso Dos Corticosteroides Como Terapia Adjuvante No Choque Séptico

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Filho

Sousa

2022

Revista Brasileira de Engenharia de Produção

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Contexto: O choque séptico consiste em um estado de falência circulatória aguda somada a um foco infeccioso ou com predomínio de componente endotóxico. Os corticosteroides são uma classe de fármacos sintetizados com base em hormônios esteroides endócrinos e tem sido usados com foco na hipoperfusão. Entretanto, a eficácia e a segurança da terapia com corticosteroides no choque séptico ainda permanecem incertas, visto que existem tanto relatos de melhora clínica quanto de efeitos adversos graves. Objetivo: Este estudo objetiva avaliar a eficácia da terapia adjuvante com corticosteroides em pacientes com choque séptico a fim de procurar se há evidências científicas que apresentem benefícios desse tratamento, bem como estabelecer, se positivo, o manejo, de acordo com as evidências, nessa patologia. Método: Caracteriza-se como uma Revisão Integrativa, a qual os artigos foram selecionados na plataforma da Biblioteca Virtual em Saúde, em que foram identificados 460 artigos, porém foram selecionados 39 dentre estes. Resultados: Esses estudos foram realizados com mais frequência nos anos de 2017, 2018 e 2019. Após a análise dos dados, sugeriu-se que essa terapêutica se relacionou com uma reversão mais rápida do choque, diminuição dos dias de uso de vasopressores e diminuem o tempo de internação em UTI. Contudo, existem riscos de efeitos adversos. Conclusão: Com isso, concluiu-se que os pacientes candidatos a esse tratamento são aqueles com maior gravidade e/ou que não respondem primeiramente a ressuscitação com fluidos e drogas vasoativas. Ademais o uso dessas medicações deve ser individualizado, levando-se em consideração o fenótipo e o genótipo de cada paciente.

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“…[ 7 ] In addition, the treatment of septic shock should not be the same in pediatric patients as that in adults, as children are not small adults, and steroid metabolism in children has specific characteristics. [ 8 ]…”

Section: Introductionmentioning

confidence: 99%