EBM Topic: Corticosteroids for treating severe sepsis and septic shock - PowerPoint PPT Presentation

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EBM Topic: Corticosteroids for treating severe sepsis and septic shock

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77 Y/O male, DM and old CVA with bed ridden. Admitted due to Urosepsis with ... 3, 2003), MEDLINE (August 2003), EMBASE (August 2003), LILACS (August 2003) ... – PowerPoint PPT presentation

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Title: EBM Topic: Corticosteroids for treating severe sepsis and septic shock


1
EBMTopic Corticosteroids for treating severe
sepsis and septic shock
  • SupervisorDr???
  • Reporter PGY???

2
  • 77 Y/O male, DM and old CVA with bed ridden.
    Admitted due to Urosepsis with septic shock.

3
EBM
  • Ppatient of septic shock
  • Istandard therapy with corticosteroids
  • Cstandard therapy
  • OMortality, Adverse effects
  • T

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Background
  • Sepsis may be complicated by impaired
    corticosteroid production.
  • Giving corticosteroids could potentially benefit
    patients.

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Objectives
  • To examine the effects of corticosteroids on
    death at one month in patients with severe sepsis
    and septic shock.

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Search strategy
  • We searched the Cochrane Infectious Diseases
    Groups trial register (August 2003), the
    Cochrane Central Register of Controlled
    Trials(CENTRAL) (The Cochrane Library Issue 3,
    2003), MEDLINE (August 2003), EMBASE (August
    2003), LILACS (August 2003), reference lists of
    articles, and also contacted trial authors.

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Selection criteria
  • Randomized and quasi-randomized controlled trials
    of corticosteroids versus placebo or supportive
    treatment in severe sepsis and septic shock.

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Data collection and analysis
  • Two pairs of reviewers agreed the eligibility of
    trials.
  • One reviewer extracted data, which was checked by
    the other reviewers and the primary author of the
    paper whenever possible.
  • We obtained some missing data from the trial
    authors.
  • We assessed trial methodological quality.

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Main results
  • We identified 15 trials (n 2023).
    Corticosteroids did not change 28-day all-cause
    mortality (15 trials, n 2022, relative risk
    (RR) 0.92, 95 confidence interval (CI) 0.75 to
    1.14 random effectsmodel) and hospital mortality
    (13 trials, n 1418, RR 0.89, 95CI 0.71 to
    1.11 random effects model)
  • however, there was statistically significant
    heterogeneity, with some evidence that this was
    related to the dosing strategy.

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Main results
  • Corticosteroids reduced intensive care unit
    mortality (4 trials, n 425, RR 0.83, 95 CI
    0.70 to 0.97),
  • increased the proportion of shock reversal by day
    7 (6 trials, n 728, RR 1.22, 95 CI 1.06 to
    1.40) and by day 28 (4 trials, n 425, RR 1.26,
    95 CI 1.04 to 1.52),
  • without increasing the rate of gastroduodenal
    bleeding (10 trials, n 1321, RR 1.16, 95 CI
    0.82 to 1.65), superinfection (12 trials, n
    1705, RR 0.93, 95 CI 0.73 to 1.18), and of
    hyperglycaemia (6 trials, n 608, RR 1.22, 0.84
    to 1.78).

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Authors conclusions
  • Overall, corticosteroids did not change 28-day
    mortality and hospital mortality in severe sepsis
    and septic shock.
  • Long course of low dose corticosteroids reduced
    28-day all-cause mortality, and intensive care
    unit and hospital mortality.

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  • Thanks for attention!
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