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Online ISSN 1827-1596
SMART 2003 - Milan, may 28-30
Medical Intensive Care Unit Raymond Poincaré Hospital Paris Ile de France Ouest School of Medicine University of Versailles-Saint Quentin en Yvelinnes Garches, France
After a period of initial enthusiasm, several trials cast serious doubts on the usefulness of corticosteroids for the treatment of patients with severe sepsis. Short course with high doses of steroides should not be given in patients with severe sepsis. The attention is now addressed to low-dose of corticosteroides. The rational for a replacement therapy with hydrocortisone in patients with cathecolamines-dependent septic shock is based on the concept that this may be complicated by an occult adrenal insufficiency and a glucocorticoid peripheral resistance syndrome. Low doses of hydrocortisone has been shown to reproduce the normal effects of cortisol: anti-inflammatory properties and an increased in the vasoconstrictor response to cathecolamines. There is no concordance in literature about the role of replacement therapy with hydrocortisone on survival in patients with septic shock. Waiting for the results of the European confirmatory phase III trial, and based on the results of the French phase III trial, one may recommended to treat septic shock patients who have a cortisol increment after ACTH of less than 9 µg/dl with 50 mg of hydrocortisone every 6 hours for seven days combined with 50 µg of fludrocortisone once a day for seven days.