EFFECT OF CORTICOSTEROIDS IN PEDIATRIC PATIENTS WITH VASOACTIVE DRUG-DEPENDENT SEPTIC SHOCK

摘要

Increased cortisol level is known to be an adaptive process for maintaining cardiac contractility, vascular tone, and blood pressure. However, the benefit of adjunctive corticosteroids in septic shock remains inconclusive. Additionally, the adverse effects of corticosteroids are often under-recognized and can be harmful. The aim of this retrospective study was to investigate the effect of adjunctive corticosteroid therapy in children with septic shock that required vasoactive support. Hemodynamic variables, inotrope score, time to cessation of vasoactive drug, mortality, and length of stay were compared between patients who received corticosteroid therapy and those who did not. Ninety-five patients met the inclusion criteria, and 32 (33.6%) of those received corticosteroids. Illness severity, as measured by median PIM II scores, was similar between the two study groups. Median inotrope scores were higher in the corticosteroid group than in the no corticosteroid group at 4 hours (20 vs 10; p=0.007), 8 hours (20 vs 10; p=0.007), and 12 hours (19 vs 9; p=0.004) after initiation of vasoactive support. There was a trend toward longer median time to cessation of vasoactive drug in the corticosteroid group, as compared to the no corticosteroid group (48.7 vs 37.0 hours; p=0.051). There were no differences between groups for ICU mortality, 28-day mortality, or ICU length of stay. In summary, no definite outcome improvement can be attributed to adjunctive corticosteroid therapy in our study patients. Further well-designed randomized controlled trials are needed to prove the benefit of this intervention in clinical practice.