Email updates

Keep up to date with the latest news and content from Critical Care and BioMed Central.

Highly Accessed Letter

Potential for overuse of corticosteroids and vasopressin in septic shock

Joe L Hsu1*, Vincent Liu2, Andrew J Patterson3, Greg S Martin4, Mark R Nicolls1 and James A Russell5

Author Affiliations

1 Department of Medicine, Division of Pulmonary and Critical Care Medicine, Stanford University Hospital, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305-5236, USA

2 Kaiser Permanente Division of Research and Systems Research Initiative, 2000 Broadway (Webster Annex), Oakland, CA 94612, USA

3 Department of Anesthesia, Stanford University Hospital, 300 Pasteur Drive, Stanford, CA 94305, USA

4 Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Emory University School of Medicine, 49 Jesse Hill Jr Drive, SE, Atlanta, GA 30303, USA

5 Critical Care Research Laboratories, Institute of Heart and Lung Health, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada

For all author emails, please log on.

Critical Care 2012, 16:447  doi:10.1186/cc11460

Published: 6 September 2012

First paragraph (this article has no abstract)

Guidelines recommend corticosteroids and vasopressin to treat septic shock as per specific indications [1]. However, the results from trials evaluating both drugs conflict. For corticosteroids, the 2002 Annane and colleagues study showed a survival benefit for hydro-cortisone/fludrocortisone treatment in patients with an inappropriate cortisol response to a high-dose adrenocorticotropic hormone (ACTH) test [2], while the Corticosteroid Therapy of Septic Shock (CORTICUS) trial found no difference in survival by patients' response to ACTH [3]. The Vasopressin and Septic Shock Trial (VASST) demonstrated a survival benefit in less severe septic shock, but guidelines espouse use 'in patients refractory to other vasopressors' [1,4]. Clinical variability, leading to overtreatment, may have negative effects on survival. To evaluate the impact of these evidence limitations, we surveyed physicians in the Critical Illness Outcomes Study (CIOS).