What is the efficacy of corticosteroid therapy in the management of multiple organ dysfunction syndrome (MODS) in sepsis?

Updated: Jan 27, 2020
  • Author: Ali H Al-Khafaji, MD, MPH; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

Despite the theoretical and experimental animal evidence supporting the use of large doses of corticosteroids in those with severe sepsis and septic shock, all randomized human studies of this practice (except a single study from 1976) found that corticosteroids did not prevent the development of shock, reverse the shock state, or improve 14-day mortality. Therefore, routine use of high-dose corticosteroids in patients with severe sepsis or septic shock is not indicated.

Although further research is required to address this issue definitively, hydrocortisone can be given at 200-300 mg/day for up to 7 days or until vasopressor support is no longer required for patients with refractory septic shock.

Trials have demonstrated positive results from administration of stress-dose corticosteroids to patients in severe and refractory shock. [26] Large clinical trials have documented a clear benefit of hydrocortisone plus fludrocortisone for adults with septic shock, reducing the time on ventilator and the severity of acute kidney injury, along with overall lower Sequential Organ Failure Assessment (SOFA) scores. [27] Thus, it is reasonable to provide stress-dose steroid coverage plus mineralocorticoid supplement to septic shock patients, and especially those who have the possibility of adrenal suppression.


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