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Efficacy of corticosteroids in the treatment of Severe Sepsis and septic shock In critical care - Literature review Example

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TABLE OF CONTENTS ABSTRACT 3 INTRODUCTION 4 AIMS AND OBJECTIVES 6 SEARCH STRATEGY 6 KEYWORDS 7 REVIEW OF LITEREATURE 8 STEROID THERAPY- CURRENT INDICATIONS IN PRACTICE AND RECOMMENDATIONS 22 CONCLUSIONS AND RECOMMENDATIONS 24 REFERENCES 26 TABLES Table 1: CEBM based steps in finding evidence for different type of questions (CEBM) 7 Table 2: Therapies Used in the Treatment of Severe Sepsis and Septic Shock (Morrel et al., 2009) 9 Table 3: Critical Appraisal for Therapy Articles Reviewed 17 Table 4: Major Recommendations of SSC 2008 for Corticosteroid usage in Severe Sepsis and Septic Shock (Miyashita, 2010) 23 FIGURES Figure 1: Protocol for Earle Goal-Directed Therapy (EGDT) (Rivers et al., 20…
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Efficacy of corticosteroids in the treatment of Severe Sepsis and septic shock In critical care
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"Efficacy of corticosteroids in the treatment of Severe Sepsis and septic shock In critical care"

Download file to see previous pages Treatment involves aggressive fluid resuscitation, antibiotics, surgical excision of infected or necrotic tissues and drainage of pus, supportive care, and sometimes intensive control of blood glucose and administration of corticosteroid and activated protein c. Adjunctive corticosteroid therapy is commonly prescribed to patients with septic shock, despite the fact that few trials show survival value. A reduction in time to shock reversal has been observed. The present study aimed to review the literature available for the efficacy of corticosteroids in the treatment of severe sepsis and septic shock. Data was gathered from articles published in peer reviewed journals. Despite the lack of consensus in the efficacy of corticosteroids in the published literature, corticosteroids were found to be safe and effective as first line treatment for septic shock, though there efficacy in severe sepsis treatment is not documented. {Key Words: Septic shock, severe sepsis, corticosteroids, hydrocortisone, critical care, adrenal insufficiency, organ dysfunction} EFFICACY OF CORTICOSTEROIDS IN TREATMENT OF SEVERE SEPSIS AND SEPTIC SHOCK INTRODUCTION Septic shock is one of the most critical complications associated with surgical cases and still one of the major causes of mortality in the intensive care units (ICUs). Shock, in general refers to a scarcity of oxygen supply leading to hypotension and hypoperfusion followed by cellular dysfunction; sepsis refers to a systemic inflammatory response to infection (Wang et al. 2009). Thus, severe sepsis can be defined as sepsis complicated by organ dysfunction, tissue or organ hypofusion; or hypotension (Balk, 2000). The organ dysfunctions associated with severe sepsis include renal, respiratory, cardiovascular, hematologic, hepatic and gastrointestinal dysfunction. Septic shock is systemic inflammatory response to infection occurring with acute respiratory failure, persistent arterial hypotension and perfusion abnormalities, in severe case leading to organ dysfunction (Bridges, 2005). Progressively increasing incidences of mortality and morbidity are reported for sepsis, severe sepsis and septic shock, respectively (Zanotti-Cavazzoni & Hollenberg, 2009). An epidemiological study of cases of severe sepsis in England, Wales and Northern Ireland for the period spanning 1996 to 2004 reported hospital mortality of 48.3% in the year 1996, which has marginally decreased to 44.7% in 2004. Moreover the total number of deaths due to severe sepsis has risen from 9,000 to 14,000 during this period due to rise in incidences of severe sepsis (Harrison et al., 2006). Another study to evaluate worldwide incidences of mortality as consequence of severe sepsis reported a marginal fall in number of deaths due to the condition, the mortality still remaining as high as 30-50% (Laterre et al., 2004). Cardiovascular and hemodynamic instability are closely associated with increase in ...Download file to see next pagesRead More
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