The controversial role of corticosteroids in septic shock

Pourmand, Ali; Whiteside, Tess; Yamane, David; Rashed, Amir; Mazer‐Amirshahi, Maryann

doi:10.1016/j.ajem.2019.04.045

Cited by 6 publications

(8 citation statements)

References 41 publications

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“…Conforme o estudo realizado, os resultados encontrados foram divididos em: artigos que mostraram efeitos e resultados positivos da corticoterapia adjuvante no choque séptico (Annane, 2019;Antcliffe & Gordon, 2019;El-Nawawy, Khater, Omar, & Wali, 2017;Fang et al, 2018;Garza et al, 2018;Gibbison et al, 2017;Law, Sahetya, Walkey, & Delaney, 2018;Lee & Yeh, 2018;Lian et al, 2019;Liu & Menon, 2018;Menon & Mcnally, 2018;Meyer et al, 2019;Pourmand, Whiteside, Yamane, Rashed, & Mazer-Amirshahi, 2019;Russell, 2018. Wen et al, 2019Wong et al, 2016;Zhou, Ye, Li, & Tang, 2018), e resultados negativos do uso complementar dos corticosteroides no choque séptico (Cvijanovich et al, 2017;Lemieux, Levine, & Gritsenko, 2019;Long & Koyfman, 2017;Moskowitz et al, 2020;Salluh & Póvoa, 2017;Yang & Sun, 2020;Zimmerman, 2018).…”

Section: Gráfico 1 Anos De Publicação Dos Artigosunclassified

Eficácia Do Uso Dos Corticosteroides Como Terapia Adjuvante No Choque Séptico

Leite

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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Section: Gráfico 1 Anos De Publicação Dos Artigosunclassified

Eficácia Do Uso Dos Corticosteroides Como Terapia Adjuvante No Choque Séptico

Leite

Filho

Sousa

2022

Revista Brasileira de Engenharia de Produção

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“…Some of this immune modulatory activity can also be present in derived exosomes (76). There is little clinical experience with cellular immunotherapy in sepsis, but two first-in-human studies showed safety (77,78). Although the CISS trial was underpowered to access changes induced in the plasma levels of cytokines, a patient-specific, dose-dependent, transient early dampening of several mediators (IL-1b, IL-2, IL-6, IL-8, and MCP-1) was identified (77).…”

Section: Painful and Inspiring Lessons From Sepsis For Covid-19 Immunmentioning

confidence: 99%

“…Although the CISS trial was underpowered to access changes induced in the plasma levels of cytokines, a patient-specific, dose-dependent, transient early dampening of several mediators (IL-1b, IL-2, IL-6, IL-8, and MCP-1) was identified (77). The other phase I study (RUMСESS) found improvement in 28-d but not in 90-d survival of neutropenic patients with septic shock (78). The phase II randomized trial CHOCMSC is under way to evaluate the efficacy of this form of cellular immunotherapy for septic shock (NCT02883803).…”

Section: Painful and Inspiring Lessons From Sepsis For Covid-19 Immunmentioning

confidence: 99%

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Immune Response Resetting as a Novel Strategy to Overcome SARS-CoV-2–Induced Cytokine Storm

Nowill

Campos-Lima

2020

The Journal of Immunology

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which rapidly became a pandemic of global proportions. Sepsis is commonly present with high lethality in the severe forms of the disease. The virus-induced cytokine storm puts the immune system in overdrive at the expense of the pathogen-specific immune response and is likely to underlie the most advanced COVID-19 clinical features, including sepsis-related multiple organ dysfunction as well as the pathophysiological changes found in the lungs. We review the major therapeutic strategies that have been considered for sepsis and might be amenable to repurposing for COVID-19. We also discuss two different immunization strategies that have the potential to confer antiviral heterologous protection: innate-induced trained immunity and adaptive-induced immune response resetting.

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“…4 These recent demonstrations of significant reductions in mortality in patients with septic shock treated with adjunctive glucocorticoid combined with fludrocortisone, as well as the effectiveness of angiotensin II in treating vasodilatory shock, have renewed interest in the role of the mineralocorticoid axis in critical illness. 1,[5][6][7] This narrative review aims to summarize current insights into the pathophysiologic mechanisms and clinical implications of the renin-angiotensin-aldosterone system in critical illness. We focus on the issue of fludrocortisone supplementation in critical illness, as well as current understanding of the role of mineralocorticoid replacement in this group of patients.…”

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confidence: 99%

Mineralocorticoid Dysfunction during Critical Illness

Nethathe¹,

Cohen²,

Lipman³

et al. 2020

Anesthesiology

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The recent demonstration of the significant reduction in mortality in patients with septic shock treated with adjunctive glucocorticoids combined with fludrocortisone and the effectiveness of angiotensin II in treating vasodilatory shock have renewed interest in the role of the mineralocorticoid axis in critical illness. Glucocorticoids have variable interactions at the mineralocorticoid receptor. Similarly, mineralocorticoid receptor–aldosterone interactions differ from mineralocorticoid receptor–glucocorticoid interactions and predicate receptor–ligand interactions that differ with respect to cellular effects. Hyperreninemic hypoaldosteronism or selective hypoaldosteronism, an impaired adrenal response to increasing renin levels, occurs in a subgroup of hemodynamically unstable critically ill patients. The suggestion is that there is a defect at the level of the adrenal zona glomerulosa associated with a high mortality rate that may represent an adaptive response aimed at increasing cortisol levels. Furthermore, cross-talk exists between angiotensin II and aldosterone, which needs to be considered when employing therapeutic strategies.

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The controversial role of corticosteroids in septic shock

Cited by 6 publications

References 41 publications

Eficácia Do Uso Dos Corticosteroides Como Terapia Adjuvante No Choque Séptico

Eficácia Do Uso Dos Corticosteroides Como Terapia Adjuvante No Choque Séptico

Immune Response Resetting as a Novel Strategy to Overcome SARS-CoV-2–Induced Cytokine Storm

Mineralocorticoid Dysfunction during Critical Illness

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