Corticosteroids in septic shock: Current evidence, controversies, and clinical implications

Background

Septic shock is the most severe cardiovascular manifestation of sepsis and remains associated with substantial morbidity and mortality despite advances in antimicrobial therapy, hemodynamic resuscitation, organ support, and critical care. Corticosteroids have been investigated for decades as adjunctive therapy because of their potential to modulate the dysregulated inflammatory response, restore vascular responsiveness to catecholamines, and compensate for abnormalities of the hypothalamic-pituitary-adrenal axis occurring during critical illness. Nevertheless, uncertainty remains regarding their effect on mortality, the optimal corticosteroid regimen, the role of mineralocorticoid supplementation, and the ideal timing of treatment.

Objective