New insights into the management of severe sepsis and septic shock

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Systemic corticosteroids Annane’s practice-changing study published in 2002showed that among 300 septic shock patients, thosewith a negative cosyntropin stimulation test (“nonresponders”)randomized to 50 mg hydrocortisone IV q6 hours had significantly improved 28-day mortalitycompared to placebo (53% vs. 68%). CORTICUS (2008) then swung the pendulum back byshowing no 28-day mortality benefit of steroids in 499septic shock patients (39% vs. 36%) who were nonrespondersto cosyntropin. Steroids did reduce thetime spent in shock (3.3 vs. 5.8 days), but steroidtreatedpatients had more superinfections and newepisodes of sepsis
Systemic corticosteroidsSumming up, corticosteroids do improveblood pressure, but any beneficial effectson survival from septic shock remain hotlydebated
Page 1 and 2: Surviving Sepsis Campaign UpdatedGu
Page 3 and 4: Guide to Recommendations’ Strengt
Page 5 and 6: Definitions Severe sepsis is define
Page 7: Prognosis More than half of all sep
Page 10 and 11: Early haemodynamic optimization(res
Page 12 and 13: Early haemodynamic optimization(res
Page 14 and 15: Components of EGDT(resuscitation bu
Page 16 and 17: Surviving Sepsis: New monitoringrec
Page 18 and 19: Surviving Sepsis: New Fluid Resusci
Page 20 and 21: Surviving Sepsis: New Recommendatio
Page 22 and 23: Inotropic therapy After adequate vo
Page 24 and 25: Decreasing oxygen consumption When
Page 27 and 28: Empirical antibiotic combinations P
Page 29 and 30: Source controlMeasures to eradicate
Page 31 and 32: Drotrecogin alfa (activated protein
Page 33: Systemic corticosteroids Despite mo
Page 37: Surviving Sepsis guidelines regardi

New insights into the management of severe sepsis and septic shock

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