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Corticosteroids in the Sepsis Syndrome

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Update 1987

Part of the book series: Update in Intensive Care and Emergency Medicine ((UICM,volume 3))

Abstract

The mechanisms for many of the changes that occur in the sepsis syndrome have eluded investigators for years. Despite the fact that we have made great progress in evaluating the role of the coagulation, complement, arachidonic acid and other systems in the sepsis syndrome, we have not been able to clearly differentiate the initiating event causing the alterations from the “innocent bystanders”. Without a clearer understanding of the epidemiology and the pathophysiologic mechanisms causing the changes in the sepsis syndrome, it may be unrealistic to expect major improvement in survival with our current therapeutic modalities. The present chapter will summarize some of the animal and human data concerning the use of corticosteroids in the sepsis syndrome. We have defined the sepsis syndrome as a spectrum of disease from early sepsis — a systemic response to invading microorganisms to septic shock. A more detailed review of the subject can be found elsewhere [1, 2].

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References

  1. Schein RMH, Sprung CL (1986) The use of corticosteroids in the sepsis syndrome. Fuller-ton CA, Society of Critical Care Medicine, 7:131–149

    Google Scholar 

  2. Schein RMH, Long WM, Sprung CL (1986) Controversies in the management of sepsis and septic shock: Corticosteroids, naloxone and nonsteroidal anti-inflammatory agents. In: Sibbald WJ, Sprung CL (eds) New Horizons — Perspectives on sepsis and septic shock. Fuller-ton CA, Society of Critical Care Medicine, pp 339–368

    Google Scholar 

  3. Melby J (1970) Pathophysiology of shock. In: Schumer W, Nyhus LM (eds) Corticosteroids in the Treatment of Shock. Urbana, University of Illinoi Press, pp 1–6

    Google Scholar 

  4. Weismann G, Thomas L (1962) Studies on lysosomes. 1. The effect of endotoxin tolerances and cortisone on the release of acid hydrolases from a granular fraction of rabbit liver. J Exp Med 116:433–450

    Article  Google Scholar 

  5. Jacob HS, Craddock PR, Hammerschmidt DE, et al (1980) Complement-induced granulocyte aggregation: An unsuspected mechanism of disease. N Engl J Med 302:789–794

    Article  PubMed  CAS  Google Scholar 

  6. Sibbald WJ, Anderson RR, Reid B, Holliday RC, Driedger AA (1981) Alveolo-capillary permeability in human septic ARDS: Effect of high-dose corticosteroid therapy. Chest 79:133–142

    Article  PubMed  CAS  Google Scholar 

  7. Melby JC (1974) Systemic corticosteroid therapy. Pharmacology and endocrinologic considerations. Ann Intern Med 81:505–512

    PubMed  CAS  Google Scholar 

  8. Ottoson J, Brandberg A, Erikson B, et al (1982) Experimental septic shock — effects of corticosteroids. Circ Shock 9:571–577

    Google Scholar 

  9. Hinshaw LB, Solomon LA, Freeny PC, et al (1967) Hemodynamic and survival effects of methylprednisolone in endotoxin shock. Arch Surg 94:61–66

    Article  PubMed  CAS  Google Scholar 

  10. White GL, Archer LT, Beller BK, et al (1978) Increased survival with methylprednisolone treatment in canine endotoxin shock. J Surg Res 25:357–364

    Article  PubMed  CAS  Google Scholar 

  11. Hinshaw LB, Beller BK, Archer LT, et al (1979) Recovery from lethal E.coli shock in dogs. Surg Gynecol Obstet 149:545–552

    PubMed  CAS  Google Scholar 

  12. Hinshaw LB, Archer LT, Beller-Todd BK, et al (1980) Survival of primates in LD 100 septic shock following steroid-antibiotic therapy. J Surg Res 28:151–170

    Article  PubMed  CAS  Google Scholar 

  13. Hinshaw LB, Archer LT, Beller-Todd BK, et al (1981) Survival of primates in lethal septic shock following delayed treatment with steroid. Circ Shock 8:291–300

    PubMed  CAS  Google Scholar 

  14. Hinshaw LB, Beller-Todd BK, Archer LT, et al (1981) Effectiveness of steroid/antibiotic treatment in primates administered LD100 Escherichia coli. Ann Surg 194:51–56

    Article  PubMed  CAS  Google Scholar 

  15. Hinshaw LB, Beller-Todd BK, Archer LT (1982) Current management of the septic shock patient: Experimental basis for treatment. Circ Shock 9:543–553

    PubMed  CAS  Google Scholar 

  16. Weitzman S, Berger S (1974) Clinical trial design in studies of corticosteroids for bacterial infections. Ann Intern Med 81:36–42

    PubMed  CAS  Google Scholar 

  17. Kreger BE, Craven DE, McCabe WR (1980) Gram-negative bacteremia IV: Re-evaluation of clinical features and treatment in 612 patients. Am J Med 68:344–355

    Article  PubMed  CAS  Google Scholar 

  18. Schumer W (1976) Steroids in the treatment of clinical septic shock. Ann Surg 184:333–341

    Article  PubMed  CAS  Google Scholar 

  19. Shine KI, Kuhn M, Young LS, et al (1980) Aspects of the management of shock. Ann Intern Med 93:723–734

    PubMed  CAS  Google Scholar 

  20. Blaisdell FW (1981) Controversy in shock research con: The role of steroids in septic shock. Circ Shock 8:673–682

    PubMed  CAS  Google Scholar 

  21. Hoffman SL, Punjabi NH, Kumalas S, et al (1984) Reduction of mortality in chloramphenicol treated severe typhoid fever by high-dose dexamethasone. N Engl J Med 310:82–88

    Article  PubMed  CAS  Google Scholar 

  22. Sprung CL, Caralis PV, Marcial E, et al (1984) The effects of high-dose corticosteroids in patients with septic shock: A prospective, controlled study. N Engl J Med 311:1137–1143

    Article  PubMed  CAS  Google Scholar 

  23. Sheagren JN (1981) Septic shock and corticosteroids. N Engl J Med 305:456–458

    Article  PubMed  CAS  Google Scholar 

  24. Weigelt JA, Norcross JF, Borman KR, Synder WH (1985) Early steroid therapy for respiratory failure. Arch Surg 120:536–540

    Article  PubMed  CAS  Google Scholar 

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© 1987 Springer-Verlag Berlin Heidelberg

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Sprung, C.L., Schein, R.M.H. (1987). Corticosteroids in the Sepsis Syndrome. In: Vincent, J.L. (eds) Update 1987. Update in Intensive Care and Emergency Medicine, vol 3. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-83042-6_11

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  • DOI: https://doi.org/10.1007/978-3-642-83042-6_11

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-17576-6

  • Online ISBN: 978-3-642-83042-6

  • eBook Packages: Springer Book Archive

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