Glucocorticoids and sepsis

Although systemic inflammation is the hallmark of sepsis, the use of glucocorticoids remained controversial during many years. Gluco-corticoids exert key actions during sepsis, interacting with metabolism, immune and cardiovascular systems. Glucocorticoid insufficiency is common during sepsis and may result from insufficient production of cortisol or peripheral tissues resistance. Thus, recent randomised trials showed that a replacement therapy with long course of low dose corticosteroids reduced mortality from septic shock. Improvement in survival may result from reduced duration of shock, alleviation of the systemic inflammatory response, and reduction in the number and intensity of organs dysfunction. This article summarises why, when and how glucocorticoids should be used in the management of septic shock.