A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock.

  title={A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock.},
  author={Roger C. Bone and Charles Jack Fisher and Terry P. Clemmer and Gus J. Slotman and Craig A. Metz and Robert A. Balk},
  journal={The New England journal of medicine},
  volume={317 11},
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… 

Early methylprednisolone treatment for septic syndrome and the adult respiratory distress syndrome.

It is concluded that early treatment of septic syndrome with MPSS does not prevent the development of ARDS and increases the mortality rate in patients with ARDS.

Low-dose hydrocortisone in patients with cirrhosis and septic shock: a randomized controlled trial

Despite initial favourable effects on hemodynamic parameters, hydrocortisone therapy did not reduce mortality and was associated with an increase in adverse effects.

Ineffectiveness of high-dose methylprednisolone in preventing parenchymal lung injury and improving mortality in patients with septic shock.

We conducted a prospective, randomized, double-blind study to determine whether high-dose methylprednisolone could prevent parenchymal lung injury, including the adult respiratory distress syndrome

Reversal of late septic shock with supraphysiologic doses of hydrocortisone.

Administration of modest doses of hydrocortisone in the setting of pressor-dependent septic shock for a mean of >96 hrs resulted in a significant improvement in hemodynamics and a beneficial effect on survival.

Meta-Analysis: The Effect of Steroids on Survival and Shock during Sepsis Depends on the Dose

Recent clinical trials with previous clinical trials of steroid use in patients with sepsis are compared to determine whether administering glucocorticoids in dosages similar to the amount produced physiologically during a stressful state affects outcome in septic patients.

Stress doses of hydrocortisone reverse hyperdynamic septic shock: a prospective, randomized, double-blind, single-center study.

Infusion of stress doses of hydrocortisone reduced the time to cessation of vasopressor therapy in human septic shock and was associated with a trend to earlier resolution of sepsis-induced organ dysfunctions.

CAGS and ACS evidence based reviews in surgery. 35: Efficacy and safety of low-dose hydrocortisone therapy in the treatment of septic shock.

Hydrocortisone cannot be recommended as general adjuvant therapy for septic shock (vasopressor responsive), nor can corticotrophin testing be recommended to determine which patients should receive hydroc Cortisone therapy.

Effect of Hydrocortisone on Development of Shock Among Patients With Severe Sepsis: The HYPRESS Randomized Clinical Trial.

Among adults with severe sepsis not in septic shock, use of hydrocortisone compared with placebo did not reduce the risk of septicshock within 14 days, and these findings do not support the use ofHydroc Cortisone in these patients.

Steroids for septic shock: back from the dead? (Con).

Concerns regarding a trend for higher mortality among corticotropin responders and the possibility that patients with true adrenal insufficiency may have been enrolled in this placebo-controlled trial, potentially skewing results, should be considered.



The effects of high-dose corticosteroids in patients with septic shock. A prospective, controlled study.

It is concluded that corticosteroids do not improve the overall survival of patients with severe, late septic shock but may be helpful early in the course and in certain subgroups of patients.

Steroids in the Treatment of Clinical Septic Shock

Overall mortality was significantly less in the steroid-treated group than in the control group, and there was no significant difference in mortality rate between DMP- and MPS-treated patients.

Early steroid therapy for respiratory failure.

We performed a randomized double-blind trial to determine the usefulness of early methylprednisolone therapy for patients with pulmonary failure. We selected 81 acutely ill, mechanically ventilated

High-dose corticosteroids for septic shock.

  • E. Kass
  • Medicine
    The New England journal of medicine
  • 1984
No aspect of clinical medicine is more dramatic than the presentation of severe infection with vasomotor collapse, and none more difficult to evaluate and to treat successfully. Every clinician has

Methylprednisolone prevention of increased lung vascular permeability following endotoxemia in sheep.

It is concluded that large doses of methylprednisolone given before or soon after endotoxemia prevent the increase in lung vascular permeability that endotoxin causes, but do not reverse the abnormality once it occurs.

The risk factors, incidence, and prognosis of ARDS following septicemia.

It is concluded that ARDS frequently complicates all forms of septicemia and significantly worsens the prognosis and is usually preceded by shock and thrombocytopenia.

Considerations in the therapy of septic shock.

  • P. Karakusis
  • Medicine, Biology
    The Medical clinics of North America
  • 1986

Distributions of cardiopulmonary variables in pediatric survivors and nonsurvivors of septic shock

The association of cardiopulmonary variables with outcome was investigated in 42 pediatric patients with septic shock and isolated patient groups with survival rates of 59% to 75%, compared to the overall survival rate.