Early dexamethasone treatment for septic shock patients: a prospective randomized clinical trial

Abstract

CONTEXT AND OBJECTIVE: Sepsis and septic shock are very common conditions among critically ill patients that lead to multiple organ dysfunction syndrome (MODS) and death. Our purpose was to investigate the effi cacy of early administration of dexamethasone for patients with septic shock, with the aim of halting the progression towards MODS and death. DESIGN AND SETTING:Prospective, randomized, double-blind, single-center study, developed in a surgical intensive care unit at Hospital das Clíni-cas, Faculdade de Medicina da Universidade de São Paulo. METHODS:The study involved 29 patients with septic shock. All eligible patients were prospectively randomized to receive either a dose of 0.2 mg/kg of dexamethasone (group D) or placebo (group P), given three times at intervals of 36 hours. The patients were monitored over a seven-day period by means of the sequential organ failure assessment score. RESULTS:Patients treated with dexamethasone did not require vasopressor therapy for as much time over the seven-day period as did the placebo group (p = 0.043). Seven-day mortality was 67% in group P (10 out of 15) and 21% in group D (3 out of 14) (relative risk = 0.31, 95% confidence interval 0.11 to 0.88). Dexamethasone enhanced the effects of vasopressor drugs. CONCLUSIONS:Early treatment with dexamethasone reduced the seven-day mortality among septic shock patients and showed a trend towards reduction of 28-day mortality.

Adjunct Therapy for Sepsis: How Early?

“…Five randomized clinical trials investigated the effects of prolonged treatment with corticosteroid at moderate doses when initiated within 24 hours of onset of severe sepsis [2,[19][20][21][22][23]. In these trials, 118 deaths occurred among the 222 corticosteroid-treated patients and 139 deaths among the 223 controls (RR=0.85; 95% CI, 0.73-0.99; P=0.03).…”

Adjunctive therapies in severe sepsis and septic shock: Current place of steroids

“…A randomized study enrolled 29 patients with septic shock who received 0.2 mg/kg dexamethasone or placebo (3 times every 36 h) and reported signifi cantly faster shock reversal, reduced 7-day mortality (67% vs 21%), and a trend toward reduction in 28-day mortality [ 16 ]. An open-label, randomized study investigated a 3-day therapy with methylprednisolone, 40 mg, in 31 patients with community-acquired pneumonia and reported shorter requirement for antibiotic use and faster resolution of clinical symptoms [ 17 ].…”

Revisão de artigos de ortopedia e medicina esportiva publicados em periódicos brasileiros

“…4 concluded that early treatment with dexamethasone reduced the seven-day mortality among septic shock patients and showed a trend towards reduction of 28-day mortality. Ribeiro et al 5 hope to suggest methodologies that will enable physicians to promote regular physical activity at appropriate levels, ensuring various benefits for the individual over the short, medium and long terms, which determines their importance in the promotion of health.…”