A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock.
ABSTRACT The use of high-dose corticosteroids in the treatment of severe sepsis and septic shock remains controversial. Our study was designed as a prospective, randomized, double-blind, placebo-controlled trial of high-dose methylprednisolone sodium succinate for severe sepsis and septic shock. Diagnosis was based on the clinical suspicion of infection plus the presence of fever or hypothermia (rectal temperature greater than 38.3 degrees C [101 degrees F] or less than 35.6 degrees C [96 degrees F]), tachypnea (greater than 20 breaths per minute), tachycardia (greater than 90 beats per minute), and the presence of one of the following indications of organ dysfunction: a change in mental status, hypoxemia, elevated lactate levels, or oliguria. Three hundred eighty-two patients were enrolled. Treatment--either methylprednisolone sodium succinate (30 mg per kilogram of body weight) or placebo--was given in four infusions, starting within two hours of diagnosis. No significant differences were found in the prevention of shock, the reversal of shock, or overall mortality. In the subgroup of patients with elevated serum creatinine levels (greater than 2 mg per deciliter) at enrollment, mortality at 14 days was significantly increased among those receiving methylprednisolone (46 of 78 [59 percent] vs. 17 of 58 [29 percent] among those receiving placebo; P less than 0.01). Among patients treated with methylprednisolone, significantly more deaths were related to secondary infection. We conclude that the use of high-dose corticosteroids provides no benefit in the treatment of severe sepsis and septic shock.
Article: MENINGOCOCCEMIA[Show abstract] [Hide abstract]
ABSTRACT: The prescription comes too late when the disease has gained strength by long delays.OVID (43 BC–18AD)REMEDIA ANORISAcquisition of the gram-negative diplococcus Neisseria meningitidis can result in asymptomatic pharyngeal colonization or invasive disease. Meningitis is the most common disease presentation and meningococcal septicemia, also called meningococcemia, is the most devastating form of meningococcal disease, with a high case-fatality rate. Meningococcemia is a medical emergency. Early recognition is essential so that appropriate antibiotic therapy and supportive care can be promptly instituted because irreversible shock and death may ensue within hours after the onset of symptoms. Meningococcal infections are contagious and household contacts of a patient should be treated with an antibiotic effective in eradicating mucosal carriage.Infectious Disease Clinics of North America 12/1996; 10(4):709-725. · 2.31 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: This is a guideline for the management of sepsis, developed by the Sepsis Registry Committee of The Japanese Society of Intensive Care Medicine (JSICM) launched in March 2007. This guideline was developed on the basis of evidence-based medicine and focuses on unique treatments in Japan that have not been included in the Surviving Sepsis Campaign guidelines (SSCG), as well as treatments that are viewed differently in Japan and in Western countries. Although the methods in this guideline conform to the 2008 SSCG, the Japanese literature and the results of the Sepsis Registry Survey, which was performed twice by the Sepsis Registry Committee in intensive care units (ICUs) registered with JSICM, are also referred. This is the first and original guideline for sepsis in Japan and is expected to be properly used in daily clinical practice. This article is translated from Japanese, originally published as "The Japanese Guidelines for the Management of Sepsis" in the Journal of the Japanese Society of Intensive Care Medicine (J Jpn Soc Intensive Care Med), 2013; 20:124-73. The original work is at http://dx.doi.org/10.3918/jsicm.20.124.Journal of intensive care. 01/2014; 2(1):55.
- Hepatology International 09/2014; 8(S2):475-480. · 2.47 Impact Factor