Hye Y Park, Gee Y Suh, Jae-Uk Song, Hongseok Yoo, Ik J Jo, Tae G Shin, So Y Lim, Sookyoung Woo and Kyeongman Jeon*
Corresponding author: Kyeongman Jeon firstname.lastname@example.org
Critical Care 2012, 16:R3 doi:10.1186/cc10601
See related letter by Sprung and Batzofin,
(2012-03-09 09:10) 1st hospital of Dalian medical university
the debates regarding the effects of stress-dose steroid in septic shock patients
have long been triggering since the treatment be firstly introduced. So far, we still
not very clear whether a key point or points exist for the successful steroid treatment.
In our opinion, Dr. Kyeongman Jeon and his colleagues just prove that timing of
steroid cast predominant influence on the septic shock patient��s outcomes .
According to the ��surviving sepsis campaign�� guideline, stress-dose steroid therapy
should be initiated only ��when hypotension remains poorly responsive to adequate
fluid resuscitation and vasopressors��. However, failure in fluid resuscitation and
supporting therapies with vascular active drugs for septic shock patients actually
indicate the vulnerable patient��s hemodynamic situation and global organ perfusion
already be very instable and even destroyed, therefore, definitely be link to the
a serials of harmful outcomes. With this respect, it is quiet questionable that a
��delayed�� steroid therapy, other than a ��early�� choice, be recommended in international
Moreover, There were already many comparisons and interpretations for the different
results between Prof. Annane��s study and CORTICUS trial. We noticed Annane
and his cooperators initiated steroid within 3-8 hours of the onset of septic shock
symptom and randomization, which very same as Dr. Kyeongman Jeon study(mean 6.5 hours)
. By contrast, CORTIUCS investigators started that within 72h, ��as defined by a systolic
blood pressure of less than 90 mm Hg despite adequate fluid replacement or a need
for vasopressors for at least 1 hour��. Theoretically, it is reasonable that exacerbation
in hemodynamic parameters last as long as 24-72 hours may easily associated with higher
mortality rate in septic shock patients, regardless which drug they prefer after
In summary, we believe that Dr. Kyeongman Jeon and previous Prof. Annane��s studied
already highlight tracks we should explore further to rescue our patients. And it
is also a very important implication for the future investigations targeting steroid
in septic shock, for example, ADRENAL trial(NCT01448109)in Australia and new Zealand.
The beneficial effects of aggressive steroid therapy may hide in early treating stage
of septic shock.
1.Park HY, Suh GY, Song JU, Yoo H, Jo IJ, Shin TG, Lim SY, Woo S, Jeon K: Early initiation
of low-dose corticosteroid therapy in the management of septic shock: a retrospective
observational study. Crit Care 2012,16:R3.
2.Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus
DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini
JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender
JS, Zimmerman JL, Vincent JL: Surviving Sepsis Campaign: international guidelines
for management of severe sepsis and septic shock: 2008. Crit Care Med 2008, 36:296-327.
3.Annane D, Sebille V, Charpentier C, Bollaert PE, Francois B, Korach JM, Capellier
G,Cohen Y, Azoulay E, Troche G, Chaumet-Riffaud P, Bellissant E: Effect of treatmentwith
low doses of hydrocortisone and fludrocortisone on mortality in patients with septic
shock. JAMA 2002, 288:862-871.
4.Sprung CL, Annane D, Keh D, Moreno R, Singer M, Freivogel K, Weiss YG, Benbenishty
J, Kalenka A, Forst H, Laterre PF, Reinhart K, Cuthbertson BH, Payen D, Briegel J:
Hydrocortisone therapy for patients with septic shock. N Engl J Med 2008, 358:111-124.
No competing interests.
BioMed Central Ltd unless otherwise stated. Part of Springer Science+Business Media.