Hadassah study turns tables on septic shock treatment

New study says treatment with steroids may not only be unhelpful but even harmful.

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An international study led by Hadassah-University Medical Center researchers urges intensive-care physicians to stop their widespread practice of treating patients who are in septic shock with steroids, even in small doses, as these do not help and may even harm them. Prof. Charles Sprung, director of Hadassah's general intensive care unit in the department of anesthesiology and critical care medicine, recommends instead giving the long-standard treatment of antibiotics, fluid infusions, and if needed, vasopressor therapy such as norepinephrine (such drugs raise blood pressure and help maintain the circulation of vital regions such as the myocardium of the heart and the brain). Sprung was the study coordinator of a three-and-a-half-year study on 500 patients in nine countries: Austria, Belgium, France, Germany, Italy, Israel, The Netherlands, Portugal and the United Kingdom. A report has just been published in the prestigious New England Journal of Medicine (NEJM). His team found there was no difference in death rates between the patients who received steroids and those who received a harmless placebo. Although patients who reversed their shock did so more quickly if they received steroids, patients receiving steroids developed more secondary infections. As a result of the Hadassah-led research, international guidelines for the treatment of septic shock patients have been changed and published in this month's edition of the journal Critical Care Medicine. Sepsis - the body's response to an infection - is a major worldwide cause of death, and sepsis patients fill intensive care wards. Septic shock, the most severe form of sepsis, occurs in up to a fifth of hospitalized patients. Some 30 to 60 percent of them die even after receiving the appropriate treatment. Although children, the elderly and others with weak immune systems are the most common victims, normally healthy people who are in road accidents or develop infections can also get septic shock. "It's clear that septic shock in the typical patient should not be treated with the addition of steroids to standard treatment," Sprung wrote. "I hope that the use of steroids will decrease as a result of the updated international guidelines, and many lives will be saved." In addition to standard treatment for septic shock, hospitals around the world are also using steroids as adjunct therapy to help hundreds of thousands of such patients fight for their lives. Heavy use of steroids on septic shock patients nearly stopped after the NEJM published an initial study by Sprung 24 years ago, but in the late 1990s, studies by several European research teams brought lower doses of steroids back for such patients. Since the main study showing the benefit of steroids in treating septic shock studied very ill patients, it was necessary to do the same study with typical patients.