How Do Steroids Affect Patients in Septic Shock?

MedicalResearch.com Interview with:

hospital bed CDC image

CDC image

Bala Venkatesh, MBBS, MD(Int.Med), FRCA, FFARCSI, MD(UK), FCICM
Director of Intensive Care, Wesley Hospital
Pre-eminent specialist, Princess Alexandra Hospital
Professor of Intensive Care,University of QLD
Honorary Professor, University of New South WalesProfessorial Fellow, The George Institute for Global Health

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Whether hydrocortisone reduces mortality in patients with septic shock is unclear. The uncertainty about the efficacy of glucocorticoids in reducing mortality in patients with septic shock has resulted in widespread variation in clinical practice

In the results published in the New England Journal of Medicine the investigators found steroids not only reduced the duration of septic shock, they also led to less blood transfusions, and the time spent on life support therapy in intensive care. However, the use of steroids did not lead to fewer deaths overall compared to placebo.

Some of the findings are consistent with previous research whilst other results add new information that will inform clinicians.

Our results show there is still a lot to learn about septic shock which kills up to half of those affected in some parts of the world. There are undoubtedly many other contributors to survival which we don’t yet understand. 

MedicalResearch.com: What effect do you think these results should have on treatment? What effect do you predict they will have?

Response: Clinicians are likely to use steroids for the treatment of septic shock, primarily to reduce the severity and duration of shock and to result in shorter hospital admissions. They will also lead to a reduction in resources. 

MedicalResearch.com: Why wasn’t this treatment tested this way long before now?

Response: The ability to conduct large scale high quality trial of this magnitude is limited. Such trials will require substantial funding and a coordinated network of researchers which is unique to Australia and New Zealand.

MedicalResearch.com: What recommendations do you have for future research?

Response: Next steps include conducting further genomic analyses in specific patient sub groups and longer term follow up in survivors to assess functional outcomes. The George Institute is also undertaking detailed health economic analyses.

Citations:

 Adjunctive Glucocorticoid Therapy in Patients with Septic Shock

Balasubramanian Venkatesh, M.D., Simon Finfer, M.D., Jeremy Cohen, M.D., Ph.D., Dorrilyn Rajbhandari, R.N., Yaseen Arabi, M.D., Rinaldo Bellomo, M.D., Laurent Billot, M.Sc., M.Res.,

Maryam Correa, Ph.D., Parisa Glass, Ph.D., Meg Harward, R.N., Christopher Joyce, M.D., Ph.D., Qiang Li, M.Sc., Colin McArthur, M.D., Anders Perner, M.D., Ph.D., Andrew Rhodes, M.D., Kelly Thompson, R.N., M.P.H., Steve Webb, M.D., Ph.D., and John Myburgh, M.D., Ph.D.

for the ADRENAL Trial Investigators and the Australian–New Zealand Intensive Care Society Clinical Trials Group*

January 19, 2018
DOI: 10.1056/NEJMoa1705835

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