Role of steroids in septic shock: Assessment of knowledge, attitudes and practices among intensivists practising in Hyderabad
Palepu B. Gopal, Ravichandra Raya, Rashmi R. Satapathy, Venugopal V. Madgundi
Keywords :
Knowledge, attitude and practices study, septic shock, steroids
Citation Information :
Gopal PB, Raya R, Satapathy RR, Madgundi VV. Role of steroids in septic shock: Assessment of knowledge, attitudes and practices among intensivists practising in Hyderabad. Indian J Crit Care Med 2009; 13 (3):143-147.
Context: Use of steroids in septic shock is an issue of contention, more so with two major trials reporting conflicting results. Aims: To assess the current knowledge, attitudes and practices (KAP) related to the role of steroids in septic shock among intensivists practising in Hyderabad. Setting, Design, Materials and Methods: Questionnaires containing 10 questions pertaining to the role of steroids in septic shock, were distributed to 76 intensivists during the monthly critical care meeting. Results: A great majority of intensivists (82%) agreed that the role of steroids is restricted to septic shock not responding to vasopressors. There was no clear consensus regarding the role of corticotropin stimulation test or the timing of total cortisol level testing, if it has to be performed. Hydrocortisone was clearly the choice of steroid for most intensivists and intravenous bolus injection being the preferred route of administration. There was no agreement regarding the dose of steroids, the role of fludrocortisone and whether steroids should be tapered. Most of the respondents did not extend the steroid therapy beyond seven days and the most common side effect reported was hyperglycemia. Conclusion: There is a lot of ambiguity in the knowledge, attitudes or practices regarding role of steroids in septic shock among intensivists in Hyderabad. Uniform policies and protocols need to be devised at institutional level, with multispecialty inputs, and doctors need to be familiarized accordingly.
Current concepts on the management of shock. Circulation 1957;16:1097-105.
Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 2002;288:862-71.
CORTICUS Study Group. Hydrocortisone therapy for patients with septic shock. N Engl J Med 2008;358:111-24.
Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock. Crit Care Med 2008;36:296-327.
American College of Critical Care Medicine. Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: Consensus statements from an international task force by the American College of Critical Care Medicine. Crit Care Med 2008;36:1937-49.
From mega to more reasonable doses of corticosteroids: A decade to recreate hope. Crit Care Med 1999;27:672-4.
Effect of corticosteroids on nuclear factor-kappaB activation and hemodynamics in late septic shock. Crit Care Med 2001;29:1074-7.
The effect of stress doses of hydrocortisone during septic shock on posttraumatic stress disorder and health-related quality of life in survivors. Crit Care Med 1999;27:2678-83.
Adrenal insufficiency during septic shock. Crit Care Med 2003;31:141-5.
Biphasic changes in hypothalamo-pituitary-adrenal function during the early recovery period after major abdominal surgery. J Clin Endocrinol Metab 1991;73:111-7.
Physiological-dose steroid therapy in sepsis. Crit Care 2002;6:251-8.
Steroids in the treatment of clinical septic shock. Ann Surg 1978;184:333-9.
Drugs in Lung Disease. In: Seaton A, Seaton D, Leitch AG, editors. Crofton and Douglas′s respiratory diseases. 5 th ed. Oxford: Blackwell Science Ltd; 2000. p. 193-311.
Stress doses of hydrocortisone reverse hyperdynamic septic shock: A prospective, randomized, double-blind, single-center study. Crit Care Med 1999;27:723-32.
Meta-analysis: The effect of steroids on survival and shock during sepsis depends on the dose. Ann Intern Med 2004;141:47-56.
Surviving sepsis campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004;32:858-73.
Corticosteroid treatment for sepsis: A critical appraisal and meta-analysis of the literature. Crit Care Med 1995;23:1430-9.
Recovery of plasma corticotrophin and cortisol levels after a three week course of prednisolone. Thorax 1981;36:22-4.
Comparative effects of prednisone and of cortisone in suppressing the response of the adrenal cortex to exogenous adrenocorticotropin. J Clin Endocrinol Metab 1956;16:1059-74.
National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med 2006;354:1671-84.
Immunologic and hemodynamic effects of “low-dose” hydrocortisone in septic shock: A double-blind, randomized, placebocontrolled, crossover study. Am J Respir Crit Care Med 2003;167:512-20.
Molecular mechanisms of glucocorticoid action and resistance. J Steroid Biochem Mol Biol 2002;83:37-48.
Molecular physiology of the regulation of hepatic gluconeogenesis and glycolysis. Annu Rev Physiol 1992; 54: 885-909.
Corticosteroids for treating severe sepsis and septic shock. Cochrane Database Syst Rev 2004;1: CD002243.
