Corticosteroids and Human Recombinant Activated Protein C for Septic Shock - 15/08/11

Doi : 10.1016/j.ccm.2008.06.009

Gwenhaël Colin, MD, Djillali Annane, MD, PhD ^⁎
Assistance Publique Hôpitaux de Paris, General Intensive Care Unit, Hôpital Raymond Poincaré (AP-HP), Université de Versailles SQY (UniverSud Paris), 104 Boulevard Raymond Poincaré, 92380 Garches, France

Corresponding author.

Abstract

This article summarizes the current knowledge on the benefit/risk profile from the use of low-dose corticosteroids and activated protein C in treating septic shock. Physicians should consider using low-dose corticosteroids and drotrecogin alpha activated in the treatment of patients who have vasopressor-dependent septic shock with persistent signs of hypoperfusion, organ dysfunction, or hypotension. The optimal timing for initiating these treatments is from 6 to 24 hours from onset of shock. When patients are receiving these drugs, physicians should systematically screen for superinfection and serious bleeding events.

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Keywords : Clinical trials, Cardiovascular system, Inflammation, Cytokines, Survival, Metaanalysis

Plan

Corticosteroids

Summary of Putative Effects of Corticosteroids

Summary of Findings in Randomized Controlled Trials

Summary of Current Recommendations

Human recombinant activated protein C

Summary of Putative Effects

Summary of Findings in Randomized Clinical Trials

Recommendations

Summary

Djillali Annane received funding support through grants from the French Ministry of Health for research related to (1) the prognostic value of corticotropin tests in septic shock, (2) the French multicenter randomized controlled trial on a combination of hydrocortisone and fludrocortisone, (3) the ongoing French multicenter 2×2 factorial study that compares strict glucose control versus conventional treatment for steroid-treated septic shock, and that compares hydrocortisone alone versus a combination of hydrocortisone and fludrocortisone, and (4) the French multicenter 2×2 factorial trial that compares a combination of hydrocortisone and fludrocortisone with activated protein C; with a combination of hydrocortisone, fludrocortisone, and activated protein C; and with placebos for the treatment of septic shock.