SCCM Resource Library-The Practical Magic of Steroids in Sepsis

Video Transcription

Video Summary

In this session, the speakers discuss the practical use of steroids in sepsis. They start by discussing the role of laboratory tests in determining the need for steroids, focusing on the ACTH stimulation test and the plasma cortisol level. They highlight the limitations of these tests, including uncertainties in their applicability in critical illness and lack of consistent relationship with illness severity. The speakers conclude that at this time, laboratory tests should not be routinely used to guide steroid therapy in critical illness. <br /><br />Next, they discuss the use of steroids in septic shock. They review the evidence from several landmark studies and guidelines, emphasizing the mortality benefit and other positive outcomes associated with the use of steroids in septic shock. They recommend considering the acuity of illness when deciding to initiate corticosteroid therapy. They also discuss the duration of therapy, highlighting the lack of consensus on the optimal duration of treatment. <br /><br />Finally, they discuss the discontinuation of steroids in septic shock. They stress the importance of tapering corticosteroids to prevent rebound inflammation and highlight the potential harm of abrupt withdrawal. They recommend discontinuing steroids when the patient no longer requires vasopressor therapy and caution against rapid tapering.

Asset Subtitle

Sepsis, Pharmacology, 2021

Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Learning Objectives

Assess available laboratory tests for the diagnosis of critical illness-related corticosteroid insufficiency
Determine the role of fludrocortisone as an additive agent
Discuss criteria for when, and strategies for how, to discontinue steroids

Laboratory Tests: Necessary or Wasteful?
Kimberly B. Clark

Steroids in Septic Shock
Gregory J. Peitz

When and How Should Steroids Be Discontinued?
Stephen M. Pastores

Meta Tag

Content Type Presentation

Knowledge Area Sepsis

Knowledge Area Pharmacology

Knowledge Level Foundational

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Shock

Tag Inflammation

Tag Pharmacokinetics Pharmacodynamics

Year 2021

Keywords

steroids

sepsis

laboratory tests

critical illness

septic shock

mortality benefit

corticosteroid therapy

discontinuation of steroids

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