High-dose corticosteroids in the critically ill patient. Current concept and future developments.

There are no generally accepted findings to support the use of corticosteroid in cardiogenic, hemorrhagic or septic shock in the human. Furthermore, there are concerns about the safety, appropriateness and practicality of the use of corticosteroids in severe sepsis/septic shock. There is, however, abundant evidence from animal studies that large doses of corticosteroid combined with antibiotic are extremely effective in preventing or reversing the pathophysiological and lethal manifestations of E. coli-induced shock. It is important to determine if this particular therapy has human application. Results from previous clinical studies evaluating the effectiveness of corticosteroid in severe sepsis/septic shock are in marked conflict. There is now an urgent need for carefully designed clinical studies to determine if there are human subgroup populations with severe sepsis who respond similarly to the animal who can be successfully treated with high dose corticosteroid combined with conventional therapy.