Efficacy of corticosteroids in the treatment of Severe Sepsis and Literature review

Efficacy of corticosteroids in the treatment of Severe Sepsis and septic shock In particular care - Literature critique ExampleTreatment involves aggressive fluid resuscitation, antibiotics, surgical excision of infected or necrotic tissues and drainage of pus, supportive care, and sometimes intensive control of blood glucose and administration of corticosteroid and activated protein c. Adjunctive corticosteroid therapy is commonly prescribed to patients with septic shock, despite the fact that few trials demo survival value. A reduction in time to shock reversal has been observed. The present study aimed to review the literature available for the force of corticosteroids in the treatment of severe sepsis and septic shock. Data was gathered from articles create in peer reviewed journals. Despite the lack of consensus in the efficacy of corticosteroids in the published literature, corticosteroids were found to be safe and effective as first line treatment for septic shock, thoug h there efficacy in severe sepsis treatment is not documented. Key Words septicemic shock, severe sepsis, corticosteroids, hydrocortisone, critical care, adrenal gland insufficiency, organ disfunction EFFICACY OF CORTICOSTEROIDS IN TREATMENT OF SEVERE SEPSIS AND SEPTIC SHOCK INTRODUCTION Septic shock is one of the most critical complications associated with surgical cases and still one of the major causes of mortality rate in the intensive care units (ICUs). Shock, in general refers to a scarcity of oxygen supply leading to hypotension and hypoperfusion followed by cellular dysfunction sepsis refers to a systemic inflammatory response to contagious disease (Wang et al. 2009). Thus, severe sepsis can be defined as sepsis complicated by organ dysfunction, tissue or organ hypofusion or hypotension (Balk, 2000). The organ dysfunctions associated with severe sepsis include renal, respiratory, cardiovascular, hematologic, hepatic and gastrointestinal dysfunction. Septic shock is syst emic inflammatory response to infection occurring with acute respiratory failure, persistent arterial hypotension and perfusion abnormalities, in severe case leading to organ dysfunction (Bridges, 2005). Progressively increasing incidences of mortality and morbidity are reported for sepsis, severe sepsis and septic shock, respectively (Zanotti-Cavazzoni & Hollenberg, 2009). An epidemiologic study of cases of severe sepsis in England, Wales and Northern Ireland for the conclusion spanning 1996 to 2004 reported hospital mortality of 48.3% in the stratum 1996, which has marginally decreased to 44.7% in 2004. Moreover the total number of deaths due to severe sepsis has risen from 9,000 to 14,000 during this period due to rise in incidences of severe sepsis (Harrison et al., 2006). Another study to evaluate worldwide incidences of mortality as consequence of severe sepsis reported a marginal fall in number of deaths due to the condition, the mortality still remaining as high as 30-50% (Laterre et al., 2004). Cardiovascular and hemodynamic instability are closely associated with amplify in