Standard Septic Shock Treatments Ineffective

By Serena Gordon
HealthDay Reporter
Wednesday, January 9, 2008; 6:00 PM

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WEDNESDAY, Jan. 9 (HealthDay News) -- Two new studies on the treatment of septic shock question the conventional wisdom of treating with corticosteroids, intensive insulin therapy or with the synthetic fluid replacement substance called pentastarch.

The first study compared the use of hydrocortisone to a placebo in people in septic shock and found no improvement in survival rates.

The second study looked at the use of intensive insulin therapy versus a placebo, and the use of pentastarch to the more commonly used Ringer's lactate, which is saline with added lactate, chloride, potassium and calcium. Both intensive insulin and pentastarch failed to improve survival rates, and, in fact, increased the rates of serious complications so much that the trial was stopped early.

Results of both studies are published in the Jan. 10 issue of the New England Journal of Medicine.

Septic shock is "associated with significant morbidity and mortality. Standard treatment for septic shock includes antibiotics, intravenous fluids and vasopressor medicines (drugs to increase blood pressure)," explained the first study's lead author, Dr. Charles Sprung, director of the general intensive care unit, department of anesthesiology and critical care medicine at Hadassah Hebrew University Medical Center in Israel. "Until our study, doctors in hospitals around the world were also routinely using steroids as adjunct therapy to help hundreds of thousands of patients in septic shock fight for their lives. Our study demonstrates that this adjunct therapy of hydrocortisone is not helpful for most patients with septic shock and, in fact, may be harmful."

Septic shock occurs when an infection, usually bacterial, overwhelms the body's natural defenses, according to the U.S. National Institutes of Health. The major symptoms include low blood pressure and low blood flow. If not effectively treated, failure of the kidneys, liver, brain and heart may occur. Septic shock is a life-threatening condition.

The original theory behind using steroid medications to treat septic shock was that doctors hoped it would reduce the inflammation that accompanies septic shock, according to Sprung. However, along with anti-inflammatory action, steroids can also suppress the immune system, which may be detrimental for someone fighting an infection.