Highly Accessed Open Badges 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

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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).