Early initiation of low-dose hydrocortisone treatment for septic shock in adults: A randomized clinical trial

Lv, Qingquan; Gu, Xiang; Chen, Qihong; Yu, Jiangquan; Zheng, Ruiqiang

doi:10.1016/j.ajem.2017.06.004

Cited by 41 publications

(71 citation statements)

References 27 publications

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“…The benefits of low‐dose corticosteroids on shock reversal were first reported in 1991 . Since then, numerous RCTs have evaluated the effect of low‐dose steroids on shock reversal and mortality (Table ) . Although there are some differences in the regimens used (dose and duration), the method for administration (bolus vs continuous infusion), and the use of a taper, these studies have collectively shown an improvement in shock reversal with low‐dose steroid therapy.…”

Section: Corticosteroidsmentioning

confidence: 99%

“…44 Since then, numerous RCTs have evaluated the effect of low-dose steroids on shock reversal and mortality (Table 2). 12,22,[45][46][47][48][49][50][51][52][53][54][55] Although there are some differences in the regimens used (dose and duration), the method for administration (bolus vs continuous infusion), and the use of a taper, these studies have collectively shown an improvement in shock reversal with low-dose steroid therapy. The impact of steroids on mortality, however, is mixed.…”

Section: Low-dose Corticosteroidsmentioning

confidence: 99%

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Catecholamine Vasopressor Support Sparing Strategies in Vasodilatory Shock

et al. 2019

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Shock syndromes are associated with unacceptably high rates of mortality in critically ill patients despite advances in therapeutic options. Vasodilatory shock is the most common type encountered in the intensive care unit. It is manifested by cardiovascular failure, peripheral vasodilatation, and arterial hypotension leading to tissue hypoperfusion and organ failure. Hemodynamic support is typically initiated with fluid resuscitation strategies and administration of adrenergic vasopressor agents in nonresponsive patients to restore arterial pressure with subsequent adequate organ reperfusion. Unfortunately, high catecholamine dosing requirements may be necessary to achieve targeted hemodynamic goals that may increase the risk of vasopressor‐induced adverse events. The purpose of this article is to review the clinical efficacy and safety data and potential role in therapy for catecholamine‐sparing agents in vasodilatory shock. Adjunctive therapeutic options to reduce vasoactive support requirements without compromising arterial pressure include arginine vasopressin and analogs, corticosteroids, midodrine, methylene blue, and angiotensin II. Although concomitant vasopressin and corticosteroids have a more defined role in evidence‐based guidelines for managing shock, clinicians may consider other potential catecholamine‐sparing agents.

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Section: Corticosteroidsmentioning

confidence: 99%

Section: Low-dose Corticosteroidsmentioning

confidence: 99%

Catecholamine Vasopressor Support Sparing Strategies in Vasodilatory Shock

et al. 2019

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“…The mean patient age ranged from 47 ± 4 to 69 ± 11 years. Ten trials [7,9,11,13,15,16,[26][27][28][29] were multicenter, and 11 trials [10,12,[30][31][32][33][34][35][36][37][38] were single center. Eighteen trials [7, 11-13, 15, 16, 26-35, 37, 38] included only patients with septic shock, while 3 trials [9,10,36] included patients with severe sepsis or septic shock, and separate data for the septic shock patients were available.…”

Section: Study Characteristics and Interventionsmentioning

confidence: 99%

“…The most common corticosteroid used was hydrocortisone (200-300 mg per day in divided doses), which was used in 14 trials. Hydrocortisone alone was used in 14 trials [12,13,15,26,27,[29][30][31][32][34][35][36][37][38] while only 2 trials [11,16] evaluated the influence of concomitant use of fludrocortisones (50 mg per day). Lastly, 18 trials [11-13, 15, 16, 26-38] investigated a prolonged course of low-dose intravenous hydrocortisone while 3 trials [7,9,10] investigated a short course of high-dose corticosteroids.…”

Section: Study Characteristics and Interventionsmentioning

confidence: 99%

Reevaluating the Role of Corticosteroids in Septic Shock: An Updated Meta-Analysis of Randomized Controlled Trials

et al. 2018

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“…Já foi demonstrado que baixas doses de hidrocortisona, apresentam efeito protetor sobre o endotélio vascular no momento da reperfusão sanguínea por um mecanismo de estabilização de membranas e da microcirculação, diminuindo a inflamação pela inibição da liberação de citocinas pró-inflamatórias, principalmente no sistema nervoso central e do trato gastrointestinal [13][14][15][16] . Além disso, o uso de baixas doses de hidrocortisona sensibiliza o organismo aos efeitos de catecolaminas, ajuda na melhora da pressão arterial e uma reanimação mais rápida 13,15,17 . Estudos verificaram os efeitos da hidrocortisona em pacientes vitimas de trauma, choque hemorrágico e queimaduras graves 18,19 .…”

Section: Introductionunclassified

Baixas doses de hidrocortisona possuem ação protetora no choque hemorrágico em ratos

Tavares¹,

Monteiro²,

Feijó³

et al. 2017

PRMJ

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CirurgiaEste é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribution, que permite uso, distribuição e reprodução em qualquer meio, sem restrições desde que o trabalho original seja corretamente citado. Descritores: hidrocortisona; solução salina hipertônica; choque hemorrágico; isquemia; reperfusão; inflamação; gasometria; ratos. ARTIGO DESummary Purpose: To evaluate the hydrocortisone low-dose effects in hemorrhagic shock in rats. Methods: Twenty male Wistar rats were randomly distributed into 04 groups: Sham Group (GS); Shock group (CG), animals subjected to hemorrhagic shock; Group Hypertonic Saline 7.5% (GSH 7.5%), with volume replacement of saline solution at 7.5% after shock; Hydrocortisone Group (GH), animals received hydrocortisone after shock. Arterial blood gas samples and variations of the mean arterial blood pressure (MAP) were analyzed before the shock induction and after treatments. Intestinal samples were collected for histological analysis. Results: MAP was statistical significantly increased after treatment of the shock in GSH 7,5% (p=0.0001) and GH (p=0.0058) when compared to the CG. Regarding the arterial blood gas analysis, hydrocortisone increased pH of arterial blood in comparison to the GC (P=0.0372), lowered PaCO2 (p=0.0008), maintained higher levels of bicarbonate ions (p=0.0395) and lower levels of lactate (p=0.002). GH (p=0.02), as GSH7.5% (p=0.0147), showed less histological damage than the GC. Conclusion: Low dosages of hydrocortisone had protective effects against hemorrhagic shock in rats.

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Early initiation of low-dose hydrocortisone treatment for septic shock in adults: A randomized clinical trial

Cited by 41 publications

References 27 publications

Catecholamine Vasopressor Support Sparing Strategies in Vasodilatory Shock

Catecholamine Vasopressor Support Sparing Strategies in Vasodilatory Shock

Reevaluating the Role of Corticosteroids in Septic Shock: An Updated Meta-Analysis of Randomized Controlled Trials

Baixas doses de hidrocortisona possuem ação protetora no choque hemorrágico em ratos

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