Published in:
01-10-2012 | Letter
Potential for overuse of corticosteroids and vasopressin in septic shock
Authors:
Joe L Hsu, Vincent Liu, Andrew J Patterson, Greg S Martin, Mark R Nicolls, James A Russell
Published in:
Critical Care
|
Issue 5/2012
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Excerpt
Guidelines recommend corticosteroids and vasopressin to treat septic shock as per specific indications [
1]. However, the results from trials evaluating both drugs conflict. For corticosteroids, the 2002 Annane and colleagues study showed a survival benefit for hydro-cortisone/fludrocortisone treatment in patients with an inappropriate cortisol response to a high-dose adrenocorticotropic hormone (ACTH) test [
2], while the Corticosteroid Therapy of Septic Shock (CORTICUS) trial found no difference in survival by patients' response to ACTH [
3]. The Vasopressin and Septic Shock Trial (VASST) demonstrated a survival benefit in less severe septic shock, but guidelines espouse use 'in patients refractory to other vasopressors' [
1,
4]. Clinical variability, leading to overtreatment, may have negative effects on survival. To evaluate the impact of these evidence limitations, we surveyed physicians in the Critical Illness Outcomes Study (CIOS). …