Steroids sepsis corticus

Results  We identified 17 randomized trials (n = 2138) and 3 quasi-randomized trials (n = 246) that had acceptable methodological quality to pool in a meta-analysis. Twenty-eight-day mortality for treated vs control patients was 388/1099 (%) vs 400/1039 (%) in randomized trials (risk ratio [RR], ; 95% confidence interval [CI], -; P =.05; I 2 =53% by random-effects model) and 28/121 (%) vs 24/125 (%) in quasi-randomized trials (RR, , 95% CI, -; P  = .83). In 12 trials investigating prolonged low-dose corticosteroid treatment, 28-day mortality for treated vs control patients was 236/629 (%) vs 264/599 (44%) (RR, ; 95% CI, -; P  = .02). This treatment increased 28-day shock reversal (6 trials; 322/481 [%] vs 276/471 [%]; RR, ; 95% CI, -; P  = .02; I 2  = 4%) and reduced intensive care unit length of stay by days (8 trials; 95% CI, – to –; P  < .001; I 2  = 0%) without increasing the risk of gastroduodenal bleeding (13 trials; 65/800 [%] vs 56/764 [%]; P  = .50; I 2  = 0%), superinfection (14 trials; 184/998 [%] vs 170/950 [%]; P  = .92; I 2  = 8%), or neuromuscular weakness (3 trials; 4/407 [1%] vs 7/404 [%]; P  = .58; I 2  = 30%). Corticosteroids increased the risk of hyperglycemia (9 trials; 363/703 [%] vs 308/670 [46%]; P  < .001; I 2  = 0%) and hypernatremia (3 trials; 127/404 [%] vs 77/401 [%]; P  < .001; I 2  = 0%).

Because sepsis interferes with the normal distribution of systemic blood flow to organ systems, core organs may not receive appropriate oxygen delivery. The microcirculation is the key target organ for injury in patients with sepsis. A decrease in the number of functional capillaries leads to an inability to extract oxygen maximally; this inability is caused by intrinsic and extrinsic compression of capillaries and plugging of the capillary lumen by blood cells. Increased endothelial permeability leads to widespread tissue edema involving protein-rich fluid.

Every hour of delay can increase mortality by %, and time to antibiotic initiation has been shown to be the strongest predictor of patient outcome ! 19,20 In a Canadian study involving patients with meningitis, a delay of antibiotics by 6 hours increased mortality 8 fold. 21 Factors involved in antibiotic selection include assessment of the likely source, host/patient factors, and local antibiotic resistance patterns (consulting the local antibiogram is essential). Gram-positive infections account for over 50% of cases, with gram-negative accounting for approximately 35%. The important aspect is covering for suspected organisms. If the patient is unresponsive, evaluate the antibiotic regimen and ensure you have adequate coverage. Broadening antibiotics early is better than too narrow of coverage. 21,22

On a macroscopic level, sepsis progresses along a spectrum from infectious insult to septic shock and multiorgan dysfunction. 25  Septic shock is a form of distributive shock, manifested in patients by an increase in cardiac output and vasodilation. 24  The oxygen demand of end organs exceeds oxygen delivery, and with the cellular switch from aerobic to anaerobic metabolism, lactate is produced. 28  As oxygen demands remain unmatched, perfusion decreases leading to end organ failure. With each organ system failure, absolute mortality increases by 15%-20%. 27

Steroids sepsis corticus

steroids sepsis corticus

On a macroscopic level, sepsis progresses along a spectrum from infectious insult to septic shock and multiorgan dysfunction. 25  Septic shock is a form of distributive shock, manifested in patients by an increase in cardiac output and vasodilation. 24  The oxygen demand of end organs exceeds oxygen delivery, and with the cellular switch from aerobic to anaerobic metabolism, lactate is produced. 28  As oxygen demands remain unmatched, perfusion decreases leading to end organ failure. With each organ system failure, absolute mortality increases by 15%-20%. 27

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