New international research led by Hadassah University Medical Center in Jerusalem, has shown that steroids do nothing to help patients in septic shock, and may even harm them, even if given in small doses.
“Our recommendation for the typical septic shock patient is: don’t use steroids! Not even in small dozes” says Prof. Charles L Sprung, director of Hadassah’s General Intensive Care Unit within the Medical Center’s Department of Anesthesiology & Critical Care Medicine. He recommends to concentrate on the current standard treatment for these patients – Antibiotics; fluid infusions; and if needed – vasopressor therapy. Prof. Sprung was the study Coordinator of this new three and a half years study, which enrolled 500 patients in nine countries (Austria, Belgium, France, Germany, Italy, Israel, Netherlands, Portugal, United Kingdom). A report of the study appeared last week in the prestigious New England Journal of Medicine.
The study shows that: There was no difference in mortality between the patients who received steroids, and those who received placebo. Although patients who reversed their shock did so more quickly if they received steroids, patients receiving steroids developed more secondary infections.
This study was one of the reasons for updating the international guidelines for treatment of septic shock patients, which was published in the January 2008 edition of the journal, Critical Care Medicine.
"It's clear that septic shock in the typical patient should not be treated with the addition of steroids to standard treatment" says Prof. Sprung. "I hope that the use of steroids will decrease as a result of the updated international guidelines, and many lives will be saved".
Sepsis (the body's response to an infection) is a major worldwide cause of death. Septic shock, the most severe form of sepsis, occurs in up to 20% of hospitalized patients. Septic shock carries a high mortality rate: some 30 to 60 percent of patients fail to survive it even after receiving the appropriate treatment. Although children, the elderly and the immuno-compromised, whose immune systems are less efficient, are the most common victims, healthy individuals after motor vehicle accidents or with infections can also develop septic shock.
Standard treatment for septic shock includes antibiotics, intravenous fluids and vasopressor medications (drugs to increase blood pressure). In addition, hospitals around the world are also using steroids as adjunct therapy to help hundreds of thousands of patients in septic shock fight for their lives.
Heavy use of steroids to septic shock patients nearly stopped after The New England Journal of Medicine published Prof. Sprung's first study on this issue in 1984.
In the late 1990s, however, studies performed by several European research teams brought lower doses of steroids back for such patients. Since the main study showing benefit of steroids in septic shock studied extremely ill patients, it was necessary to do the same study with typical patients.