Bureaucrats, editor, reviewer, Administrators
5,246
edits
APROCCHSS: Difference between revisions
Jump to navigation
Jump to search
→Major Points
(usable) |
|||
| Line 37: | Line 37: | ||
The 2016 Surviving Sepsis Campaign severe sepsis and septic shock<ref>[http://journals.lww.com/ccmjournal/Abstract/publishahead/Surviving_Sepsis_Campaign___International.96723.aspx Rhodes A, et al. "Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock: 2016." ''Critical Care Medicine.'' 2017;45(3)1-67.]</ref> suggests using IV hydrocortisone if hemodynamics cannot be stabilized using fluids and vasopressors. This recommendation was made before the release of [[ADRENAL]] and this trial and may lead to re-evaluation of this recommendation. The seemingly contradictory findings of this trial may be attributed to the difference in severity of illness of the patients found in this trial with high mortality and severity scores as compared to other trials, as well as the use of a minerocorticoid. The findings of the trial may support the use of steroids in patients that are continuing to fail despite adequate fluid resuscitation and vasopressor support. | The 2016 Surviving Sepsis Campaign severe sepsis and septic shock<ref>[http://journals.lww.com/ccmjournal/Abstract/publishahead/Surviving_Sepsis_Campaign___International.96723.aspx Rhodes A, et al. "Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock: 2016." ''Critical Care Medicine.'' 2017;45(3)1-67.]</ref> suggests using IV hydrocortisone if hemodynamics cannot be stabilized using fluids and vasopressors. This recommendation was made before the release of [[ADRENAL]] and this trial and may lead to re-evaluation of this recommendation. The seemingly contradictory findings of this trial may be attributed to the difference in severity of illness of the patients found in this trial with high mortality and severity scores as compared to other trials, as well as the use of a minerocorticoid. The findings of the trial may support the use of steroids in patients that are continuing to fail despite adequate fluid resuscitation and vasopressor support. | ||
The cumulative trial data, some | The cumulative trial data, some demonstrating a survival advantage and others not, suggest that if steroids do in fact improve survival, the effect is probably modest at best. This idea is supported by multiple meta-analyses of trials evaluating steroids in patients with septic shock.<ref>{{#pmid:29761216}}</ref><ref>{{#pmid:29979221}}</ref> | ||
==Guidelines== | ==Guidelines== | ||