Corticosteroids for treating sepsis in children and adults

Sepsis, a 2020 review for the internist

Sepsis is an overwhelming reaction to infection that comes with high morbidity and mortality, which requires urgent interventions in order to improve outcomes. Surviving Sepsis is an international campaign that aims to improve sepsis outcomes. The 2016 guideline modifies the previous definition of sepsis and proposes some specific diagnostic and therapeutic measures, such as the protocolized use of fluid resuscitation and antibiotics. We aim to summarize the main recommendations of the 2016 guideline that are relevant to the internist and evidence-base update them to the year 2020. In the current context, this review doesn't address patients affected by SARS-COV2 induced disease.

Adverse events associated with prophylactic corticosteroid use before extubation: a cohort study

Background

Systemic corticosteroid use is recommended before extubation in mechanically ventilated patients to prevent postextubation airway complications and reintubation. However, the adverse events associated with such use remain unclear. This study aimed to describe the incidence of adverse events associated with prophylactic corticosteroid use before extubation in mechanically ventilated adult patients.

Methods

This is a retrospective cohort study of 251 mechanically ventilated adults who received prophylactic corticosteroids in the intensive care units of four tertiary-care hospitals. The patients received 20 mg methylprednisolone at 12, 8, 4, and 0 hours before extubation (total dose, 80 mg) and were followed for 72 hours after extubation. The primary outcome was a clinically significant increase in blood glucose levels of ≥100 mg/dL within 24 and 72 hours after prophylactic corticosteroid administration.

Results

Fifty-seven (23.1%) out of 247 patients and 73 (30.3%) out of 241 patients showed a clinically significant increase in blood glucose levels within 24 and 72 hours after receiving prophylactic corticosteroids, respectively. The clinically significant increase in blood glucose levels was significantly associated with underlying diabetes mellitus and was not significantly associated with hyperglycemia within 3 days before the initiation of prophylactic corticosteroids or with patient age. New-onset infections and delirium were also common, with incidences of 7.6% and 7.7%, respectively.

Conclusions

Prophylactic corticosteroid use before extubation was associated with adverse events, the most common of which was increased blood glucose levels. Lower doses of prophylactic corticosteroids may need to be considered in patients with diabetes mellitus or hyperglycemia.