Utilidad de los corticoides en el choque séptico

Autores/as

DOI:

https://doi.org/10.31790/inspilip.v6iEspecial.323

Palabras clave:

Choque Séptico, Corticoesteroides, Manejo de la Enfermedad

Resumen

Introducción: Los corticoides se han utilizado en el manejo del choque séptico con inestabilidad hemodinámica, sin embargo, su utilidad aún requiere mayor evidencia, en relación con los riesgos y beneficios asociados. Objetivo: Describir la utilidad de los corticoides en el manejo del choque séptico. Metodología: Revisión teórica de artículos publicados en las bases de datos Pubmed, Elsevier y Google Scholar, de los últimos diez años, con diseño analítico, revisiones sistemáticas o metaanálisis. Adicionalmente, se recolectaron los datos de trazabilidad de las investigaciones seleccionadas: autor/año país, revista, volumen, diseño y dirección URL/Doi. Resultados: Se incluyeron 19 artículos. En diez (52,6 %), el uso de corticoides no redujo la mortalidad. En tres (15,8 %) se sugiere que pudiera relacionarse con una reducción modesta de la mortalidad a los 28 días. En ocho (42,1 %) se plantea que el uso de corticoides pudiera ser beneficioso en la reducción del tiempo de resolución del choque, y en cuatro (21,1 %) se describe como principal complicación la hiperglucemia. Conclusión: No se encontró evidencia que sustente la efectividad de los corticoides en la reducción de la mortalidad en adultos con choque séptico; pero reducen el tiempo de recuperación. Aunque se describen efectos adversos, no influyen en el pronóstico y se consideran manejables. En definitiva, es preciso el desarrollo de investigaciones que aporten evidencia robusta acerca de la efectividad de los corticoides en el manejo del choque séptico.

Biografía del autor/a

Jaime Vargas, Universidad Central del Ecuador, Facultad de Ciencias Médicas, Quito, Ecuador.

 

Citas

 

1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA [Internet]. 2016 Feb 23;315(8):801–20. Available from: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2016.0287


2. Shankar-Hari M, Phillips GS, Levy ML, Seymour CW, Liu VX, Deutschman CS, et al. Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA [Internet]. 2016 Feb 2 [cited 2022 May 21];315(8):775. Available from: /pmc/articles/PMC4910392/


3. Chiu C, Legrand M. Epidemiology of sepsis and septic shock. Curr Opin Anaesthesiol [Internet]. 2021 Apr;34(2):71–6. Available from: https://journals.lww.com/10.1097/ACO.0000000000000958


4. Perner A, Gordon AC, Angus DC, Lamontagne F, Machado F, Russell JA, et al. The intensive care medicine research agenda on septic shock. Intensive Care Med [Internet]. 2017 Sep 12;43(9):1294–305. Available from: http://link.springer.com/10.1007/s00134-017-4821-1


5. Nandhabalan P, Ioannou N, Meadows C, Wyncoll D. Refractory septic shock: our pragmatic approach. Crit Care [Internet]. 2018 Sep 19 [cited 2022 May 21];22(1). Available from: /pmc/articles/PMC6145185/


6. Gavelli F, Castello LM, Avanzi GC. Management of sepsis and septic shock in the emergency department. Intern Emerg Med [Internet]. 2021 Sep 1 [cited 2022 May 21];16(6):1649–61. Available from: https://pubmed.ncbi.nlm.nih.gov/33890208/


7. Egi M, Ogura H, Yatabe T, Atagi K, Inoue S, Iba T, et al. The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020). J Intensive Care [Internet]. 2021 Dec 1 [cited 2022 May 21];9(1). Available from: /pmc/articles/PMC8384927/


8. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med [Internet]. 2017 Mar 1 [cited 2022 May 21];43(3):304–77. Available from: https://pubmed.ncbi.nlm.nih.gov/28101605/


9. Thompson K, Venkatesh B, Finfer S. Sepsis and septic shock: current approaches to management. Intern Med J [Internet]. 2019 Feb 1 [cited 2022 Apr 19];49(2):160–70. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/imj.14199


10. Venkatesh B, Finfer S, Cohen J, Rajbhandari D, Arabi Y, Bellomo R, et al. Adjunctive glucocorticoid therapy in patients with septic shock. N Engl J Med [Internet]. 2018 Mar 19 [cited 2022 Apr 19];378(9):797–808. Available from: https://www.nejm.org/doi/10.1056/NEJMoa1705835


11. Annane D, Renault A, Brun-Buisson C, Megarbane B, Quenot J-P, Siami S, et al. Hydrocortisone plus fludrocortisone for adults with septic shock. N Engl J Med [Internet]. 2018 Mar [cited 2022 Apr 19];378(9):809–18. Available from: https://pubmed.ncbi.nlm.nih.gov/29490185/


12. Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021 4711 [Internet]. 2021 Oct 2 [cited 2022 Apr 19];47(11):1181–247. Available from: https://link.springer.com/article/10.1007/s00134-021-06506-y


13. Lemieux SM, Levine AR. Low-dose corticosteroids in septic shock: Has the pendulum shifted? Am J Heal Pharm [Internet]. 2019 Apr 8;76(8):493–500. Available from: https://academic.oup.com/ajhp/article/76/8/493/5372612


14. Venkatesh B, Finfer S, Cohen J, Rajbhandari D, Arabi Y, Bellomo R, et al. Hydrocortisone compared with placebo in patients with septic shock satisfying the sepsis-3 diagnostic criteria and APROCCHSS Study Inclusion Criteria: A Post Hoc Analysis of the ADRENAL Trial. Anesthesiology [Internet]. 2019 Dec 1 [cited 2022 Apr 19];131(6):1292–300. Available from: https://pubmed.ncbi.nlm.nih.gov/31651531/


15. Moskowitz A, Huang DT, Hou PC, Gong J, Doshi PB, Grossestreuer A V., et al. Effect of ascorbic acid, corticosteroids, and thiamine on organ injury in septic shock: The ACTS Randomized Clinical Trial. JAMA [Internet]. 2020 Aug 18 [cited 2022 Apr 19];324(7):642–50. Available from: https://pubmed.ncbi.nlm.nih.gov/32809003/


16. Fujii T, Luethi N, Young PJ, Frei DR, Eastwood GM, French CJ, et al. Effect of vitamin C, hydrocortisone, and thiamine vs. hydrocortisone alone on time alive and free of vasopressor support among patients with septic shock: The VITAMINS Randomized Clinical Trial. JAMA [Internet]. 2020 Feb 4 [cited 2022 Apr 19];323(5):423–31. Available from: https://pubmed.ncbi.nlm.nih.gov/31950979/


17. Hussein AA, Sabry NA, Abdalla MS, Farid SF. A prospective, randomised clinical study comparing triple therapy regimen to hydrocortisone monotherapy in reducing mortality in septic shock patients. Int J Clin Pract [Internet]. 2021 Sep 1 [cited 2022 Apr 19];75(9):e14376. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/ijcp.14376


18. Rygård SL, Butler E, Granholm A, Møller MH, Cohen J, Finfer S, et al. Low-dose corticosteroids for adult patients with septic shock: a systematic review with meta-analysis and trial sequential analysis. Intensive Care Med [Internet]. 2018 Jul 14;44(7):1003–16. Available from: http://link.springer.com/10.1007/s00134-018-5197-6


19. Wu YP, Lauffenburger JC. Effectiveness of corticosteroids in patients with sepsis or septic shock using the new third international consensus definitions (Sepsis-3): A retrospective observational study. PLoS One [Internet]. 2020 Dec 1 [cited 2022 May 21];15(12):e0243149. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243149


20. Lu X, Wang X, Gao Y, Yu S, Zhao L, Zhang Z, et al. Efficacy and safety of corticosteroids for septic shock in immunocompromised patients: A cohort study from MIMIC. Am J Emerg Med [Internet]. 2021 Apr;42:121–6. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0735675720300759


21. Lu X, Han W, Gao Y, Guo S, Yu S, Yu X, et al. Efficacy and safety of corticosteroids in immunocompetent patients with septic shock. World J Emerg Med [Internet]. 2021 [cited 2022 May 21];12(2):124. Available from: /pmc/articles/PMC7947565/


22. Volbeda M, Wetterslev J, Gluud C, Zijlstra JG, van der Horst ICC, Keus F. Glucocorticosteroids for sepsis: systematic review with meta-analysis and trial sequential analysis. Intensive Care Med [Internet]. 2015 Jul 23;41(7):1220–34. Available from: http://link.springer.com/10.1007/s00134-015-3899-6


23. Kang J, Han M, Hong S-B, Lim C-M, Koh Y, Huh JW. Effect of adjunctive corticosteroid on 28-day mortality in neutropenic patients with septic shock. Ann Hematol [Internet]. 2019 Oct 20;98(10):2311–8. Available from: http://link.springer.com/10.1007/s00277-019-03785-w


24. Lyu Q-Q, Chen Q-H, Zheng R-Q, Yu J-Q, Gu X-H. Effect of low-dose hydrocortisone therapy in adult patients with septic shock: A meta-analysis with trial sequential analysis of randomized controlled trials. J Intensive Care Med [Internet]. 2020 Oct 1;35(10):971–83. Available from: http://journals.sagepub.com/doi/10.1177/0885066618803062


25. Lv Q, Gu X, Chen Q, Yu J, Zheng R. Early initiation of low-dose hydrocortisone treatment for septic shock in adults: A randomized clinical trial. Am J Emerg Med [Internet]. 2017 Dec 1 [cited 2022 Apr 19];35(12):1810–4. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0735675717304448


26. Funk D, Doucette S, Pisipati A, Dodek P, Marshall JC, Kumar A. Low-dose corticosteroid treatment in septic shock. Crit Care Med [Internet]. 2014 Nov;42(11):2333–41. Available from: http://journals.lww.com/00003246-201411000-00003


27. Lian X-J, Huang D-Z, Cao Y-S, Wei Y-X, Lian Z-Z, Qin T-H, et al. Reevaluating the role of corticosteroids in septic shock: An updated meta-analysis of randomized controlled trials. Biomed Res Int [Internet]. 2019 Jun 10;2019:1–14. Available from: https://www.hindawi.com/journals/bmri/2019/3175047/


28. Rochwerg B, Oczkowski SJ, Siemieniuk RAC, Agoritsas T, Belley-Cote E, D’Aragon F, et al. Corticosteroids in sepsis. Crit Care Med [Internet]. 2018 Sep;46(9):1411–20. Available from: http://journals.lww.com/00003246-201809000-00004


29. McDonnell E, Collins R, Hernandez M, Brown ART. Effect of hydrocortisone versus methylprednisolone on clinical outcomes in oncology patients with septic shock. J Oncol Pharm Pract [Internet]. 2021 Jan 19;27(1):54–62. Available from: http://journals.sagepub.com/doi/10.1177/1078155220910788


30. Fang F, Zhang Y, Tang J, Lunsford LD, Li T, Tang R, et al. Association of Corticosteroid Treatment With Outcomes in Adult Patients With Sepsis. JAMA Intern Med [Internet]. 2019 Feb 1;179(2):213. Available from: http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2018.5849


31. Gibbison B, López-López JA, Higgins JPT, Miller T, Angelini GD, Lightman SL, et al. Corticosteroids in septic shock: a systematic review and network meta-analysis. Crit Care [Internet]. 2017 Mar 28 [cited 2022 May 21];21(1). Available from: https://pubmed.ncbi.nlm.nih.gov/28351429/


32. Marik PE. The role of glucocorticoids as adjunctive treatment for sepsis in the modern era. Lancet Respir Med [Internet]. 2018 Oct;6(10):793–800. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2213260018302650


33. Santos Neta ABC, Chaves ACH, Dias LR, Mascarenhas IR, Macêdo IM, Guizzetti MIA, et al. Relações da corticoterapia no tratamento do choque séptico. Brazilian J Heal Rev [Internet]. 2020;3(1):1324–30. Available from: http://www.brjd.com.br/index.php/BJHR/article/view/7179/6259


34. Cohen J, Venkatesh B. Adjunctive corticosteroid treatment in septic shock. Anesthesiology [Internet]. 2019 Aug 1;131(2):410–9. Available from: https://pubs.asahq.org/anesthesiology/article/131/2/410/18110/Adjunctive-Corticosteroid-Treatment-in-Septic


35. Vandewalle J, Luypaert A, De Bosscher K, Libert C. Therapeutic mechanisms of glucocorticoids. Trends Endocrinol Metab [Internet]. 2018 Jan;29(1):42–54. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1043276017301480


36. Kapugi M, Cunningham K. Corticosteroids. Orthop Nurs [Internet]. 2019 Sep;38(5):336–9. Available from: https://journals.lww.com/10.1097/NOR.0000000000000595


37. Williams DM. Clinical Pharmacology of Corticosteroids. Respir Care [Internet]. 2018 Jun 24;63(6):655–70. Available from: http://rc.rcjournal.com/lookup/doi/10.4187/respcare.06314

38. Villalobos M, Salazar N, Valverde A, Arroyo G. Corticoesteroides en shock séptico: ¿Cuándo utilizarlos? Rev Clínica la Esc Med UCR – HSJD [Internet]. 2016;6(2):11–9. Available from: https://www.medigraphic.com/pdfs/revcliescmed/ucr-2016/ucr162i.pdf


39. Long B, Koyfman A. Controversies in corticosteroid use for sepsis. J Emerg Med [Internet]. 2017 Nov;53(5):653–61. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0736467917304705


40. Yao Y-Y, Lin L-L, Gu H-Y, Wu J-Y, Niu Y-M, Zhang C. Are Corticosteroids beneficial for sepsis and septic shock? Based on pooling analysis of 16 studies. Front Pharmacol [Internet]. 2019 Jul 12;10(2):89–95. Available from: https://www.frontiersin.org/article/10.3389/fphar.2019.00714/full


41. Mitwally H, Saad MO, Mahmoud S, Mohamed A. Hyperglycemia risk evaluation of hydrocortisone intermittent boluses vs. continuous infusion in septic shock: A retrospective study. Indian J Crit Care Med [Internet]. 2021 Jan 18;25(1):29–33. Available from: https://www.ijccm.org/doi/10.5005/jp-journals-10071-23501


42. Wen Y, Zhu Y, Jiang Q, Guo N, Cai Y, Shen X. The effectiveness and safety of corticosteroids therapy in adult critical Ill patients with septic shock: A meta-analysis of randomized controlled trials. Shock [Internet]. 2019 Aug;52(2):198–207. Available from: https://journals.lww.com/00024382-201908000-00009


43. Pourmand A, Whiteside T, Yamane D, Rashed A, Mazer-Amirshahi M. The controversial role of corticosteroids in septic shock. Am J Emerg Med [Internet]. 2019 Apr;37(7):1353–61. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0735675719302700

 

Descargas

Publicado

11/05/2022

Cómo citar

Jaime Vargas, & Mario Montalvo. (2022). Utilidad de los corticoides en el choque séptico. Revista Ecuatoriana De Ciencia, Tecnología E Innovación En Salud Pública, 6(Especial), 38/50. https://doi.org/10.31790/inspilip.v6iEspecial.323

Número

VOLUMEN 6, NÚMERO ESPECIAL NOVIEMBRE

Sección

Artículos de revisión

Licencia

Creative Commons License

Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.

Artículos más leídos del mismo autor/a

Artículos similares

1 2 3 4 5 6 7 8 9 10 > >> 

También puede Iniciar una búsqueda de similitud avanzada para este artículo.