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There are more chances of shock reversal with hydrocortisone boluses and infusions in comparison to placebo and methylprednisolone.
Corticosteroids like dexamethasone, prednisolone, methylprednisolone imitate the effects of hormones that are naturally produced by adrenal glands in the body. These are often used as medications, especially when adrenal cortex is not able to produce enough of these hormones. They have been used to treat inflammatory conditions of the skin, immune system and other organs of the body. Septic shock is a serious condition indicated by a significant decrease in blood pressure due to severe widespread infection. It can lead to respiratory or heart failure, stroke, failure of other organs and also can lead to death.
Several corticosteroids have been used as treatment regimens as adjuncts in the treatment of septic shock. However, qualitative and quantitative differences exist at cellular and tissue levels between the different drugs and their patterns of delivery. The therapeutic effects of corticosteroids in critically ill patients with sepsis are controversial. A systematic review and network meta-analysis were done to probe if there exist any differences between the drugs and their treatment regimens regarding the outcomes of corticosteroid use in adult patients with septic shock.
This study used data from Cochrane database and included randomized controlled trials with and without blinding and children and adults with sepsis. It excluded studies involving children and designed to assess respiratory function in pneumonia and acute respiratory distress syndrome, as well as cross-over studies.
All the analyses were performed using a frequentist approach assuming a random-effects model and network plots were created for each outcome.
The result was obtained from complete data of 22 studies and partial data from 1 study. Network meta-analysis showed no clear evidence clarifying the superiority of any intervention or treatment regimen over other. Strong evidence was found that in case of shock reversal that revealed that boluses and infusions of hydrocortisone were more suitable than boluses of methylprednisolone and placebo.
Overall, it was concluded that no clear evidence suggested the use of single corticosteroid drug or treatment regimen which proved to be more effective in reducing mortality or the incidence of gastrointestinal bleeding or superinfection in septic shock. Only hydrocortisone boluses and infusions were found to be more suitable in case of shock reversal.
Critical Care
Corticosteroids in septic shock: a systematic review and network meta-analysis
D'Angelo S et al.
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