Use of corticosteroids in septic shock

Corticosteroids are potent anti-inflammatory agents whose use has been life-saving in many diseases. Thus, it makes intuitive sense to use corticosteroids in septic shock, a disease where the inflammatory response is vigorously activated. Early studies examining the usage of corticosteroids in septic shock did not show any benefit, however, these studies administered very large doses. More recently, attention has been focused on the use of lower doses of corticosteroids to treat relative adrenal insufficiency in septic shock; however, results have been controversial. Multicenter double blinded, randomized trials further added to the controversy without completely clarifying the issue. Moreover, the use of corticosteroids in critical illness must balance potential benefits with minimal side effects, however even such issues remain debatable as some studies show no untoward harm while other find the opposite. This review examines the use of corticosteroids in septic shock, discusses some of the shortcomings of the major clinical trials and outlines the most recent recommendations. (Minerva Anestesiol 2011;77:190-5)