Steroids in Sepsis - ADRENAL and APROCCHSS Included in New Review

Written by Clay Smith

Spoon Feed
This rapid review by BMJ included ADRENAL and APROCCHSS along with 40 other RCTs and made a weak recommendation to use corticosteroids (CCS) for patients with sepsis. You’ll want to pull up the free full text with some great infographics.

Why does this matter?
Current sepsis guidelines do not recommend CCS except for refractory shock. How does the newer evidence affect this recommendation?

Almost equipoise
This rapid review by BMJ took into account 42 RCTs, over 10,000 patients, including the two new trials on corticosteroids (CCS) for sepsis, ADRENAL and APROCCHSS. They concluded that in light of the new information from these two major trials that they should offer a weak recommendation favoring CCS use for sepsis patients. However, they offer the caveat that CCS increased risk of muscle weakness. They also state that not giving CCS is also a reasonable approach, since the evidence in support of it is not definitive.

Another Spoonful
If you want the actual methods and publication of the meta-analysis, go here to Critical Care Medicine.

Source
Corticosteroid therapy for sepsis: a clinical practice guideline. BMJ. 2018 Aug 10;362:k3284. doi: 10.1136/bmj.k3284.

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