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Letter to the Editor

Hydrocortisone in Severe Sepsis: Time to Accept the Null Hypothesis?

Robert B. Sanda, MBBS, FRCSI, Omer A. Omer, MD
Volume: 101 Issue: 9 September, 2008

Abstract:

To the Editor:


The use of glucocorticoids in severe sepsis has had its fair share of controversy. In the 1960s, studies in animal models suggested that steroids might have survival benefits in sepsis and paved the way for trials with large doses.1 By the mid-1990s, meta-analysis disproved the efficacy of large doses of steroids with secondary infections due to the attendant immunosuppression becoming a concern.2

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References:

1. Hinshaw LB, Solomon LA, Freeny PC, et al. Endotoxin shock. Hemodynamic and survival effects of methylprednisolone. Arch Surg 1967;94:61–66.
 
2. Lefering R, Neugebauer EA. Steroid controversy in sepsis and septic shock: a meta-analysis. Crit Care Med 1995;23:1294–1303.
 
3. Briegel J, Schelling G, Haller M, et al. A comparison of the adrenocortical response during septic shock and after complete recovery. Intensive Care Med 1996;22:894–899.
 
4. Minneci PC, Deans KJ, Banks SM, et al. Meta-analysis: the effect of steroids on survival and shock during sepsis depends on the dose. Ann Intern Med 2004;141:47–56.
 
5. Sprung CL, Annane D, Keh D, et al. Hydrocortisone therapy for patients with septic shock. N Engl J Med 2008;358:111–124.

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