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Steroids in Sepsis

Steroids in Sepsis. What do we want steroids to do?. Improve Mortality Decrease Pressors Decrease Ventilator Time Decrease ICU LOS. Why do we think steroids may help?. Relative adrenal insufficiency What do glucocorticoids do during stress?. The Cosyntropin Stim Test.

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Steroids in Sepsis

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  1. Steroids in Sepsis

  2. What do we want steroids to do? • Improve Mortality • Decrease Pressors • Decrease Ventilator Time • Decrease ICU LOS

  3. Why do we think steroids may help? • Relative adrenal insufficiency • What do glucocorticoids do during stress?

  4. The CosyntropinStim Test

  5. Empiric Treatment of AI • Dexamethasone 2mg IV bolus • Hydrocortisone 50mg IV q6h

  6. How to Interpret a Stim Test

  7. Annane – Effect of Treatment with Low Doses of Hydrocortisone and Fludrocortisone on Mortality in Patients with Septic Shock (2002) • Randomized to steroid supplementation or placebo • Determined to be “responders” or “non-responders” by cosyntropin test

  8. What do we want steroids to do? • Improve Mortality (YES – in responders) • Decrease Pressors (YES – in responders)

  9. Sprung and Annane – Hydrocortisone Therapy for Patients with Septic Shock (2008) • Randomized to steroid supplementation or placebo • Determined to be “responders” or “non-responders” by cosyntropin test

  10. What do steroids really do? • Improve Mortality (?) • Decrease Pressors (?) • Decrease Ventilator Time (?) • Decrease ICU LOS (?)

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