A History of Adjunctive Glucocorticoid Treatment for Pediatric Sepsis: Moving Beyond Steroid Pulp Fiction Toward Evidence-based Medicine

Jerry J. Zimmerman, MD, PhD, FCCM

Disclosures

Pediatr Crit Care Med. 2007;8(6):530-539. 

In This Article

Cortisone Treatment of Clinical Shock

During the early 1950s, with frequent clinical and necropsy evidence for adrenal insufficiency associated with meningococcemia, children with evidence of circulatory collapse in shock were being routinely treated with cortisone. Based primarily on results of impressive animal experiments (described previously), corticosteroids were routinely used for adjunctive treatment of sepsis in the 1950s and 1960s.[30] The first clinical evidence suggesting the use of therapeutic corticosteroids for severe generalized infections was published by Hahn et al.[31] in 1951. A summary of a trial that enrolled 82 pediatric and adult subjects with severe infection was published by Jahn et al.[32] in 1954. More than half of the subjects were children, infected primarily with Haemophilus influenzae and Neisseria meningitidis. Overall mortality was ∼33%, but the investigators noted, There is no question that the administration of ACTH or cortisone in sufficient amounts to patients with severe infections will result in rapid and striking clinical improvement. Multiple small clinical investigations examining corticosteroids in this clinical setting were conducted between 1950 and 1971, but good clinical trial design was absent.[33] More than a decade passed before the first prospective, randomized, placebo-controlled trial of hydrocortisone in sepsis was conducted, by Bennett et al.[34]

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