Standard Septic Shock Treatments Ineffective

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Dr. Louis Saravolatz, an infectious disease specialist and chairman of the department of medicine at St. John Hospital and Medical Center in Detroit, also pointed out that it's possible the inflammation seen with septic shock may be part of the body's natural defense, and "maybe it's helping us fight infection."

In any case, the use of corticosteroids in septic shock has remained controversial for decades, and numerous studies have been conducted, often with conflicting results. To try to definitively assess whether or not steroids could provide benefit, Sprung and his colleagues randomly assigned almost 500 people in septic shock to receive either 50 milligrams of hydrocortisone intravenously every six hours for five days, or a placebo. The researchers found no statistically significant differences in survival between the groups. The incidence of septic shock was reversed more quickly in the corticosteroid group, but this benefit was offset by additional episodes of "super-infection" with new sepsis and septic shock.

"If it takes 30 years of study [to find a benefit], it probably isn't having a whole lot of effect," Saravolatz noted.

The second study, which was stopped early for safety reasons, sought to compare other commonly used septic shock treatments to assess their efficacy.

German researchers recruited 537 people in septic shock and randomly assigned them to receive either intensive insulin therapy or standard insulin therapy or a modified Ringer's lactate solution versus a pentastarch solution. Pentastarch is a synthetic fluid replacement substance.

The idea behind intensive insulin therapy originally came from a study of cardiac surgical patients that found when blood sugar was kept in the normal, healthy range, mortality was reduced, according to Saravolatz. "The immune system doesn't work well if blood sugar is too high," he explained.

In this study, however, the German researchers found that intensive insulin therapy didn't produce a statistically significant reduction in death rates but did increase the risk of serious adverse events, such as critically low blood sugar (hypoglycemia). In the intensive insulin group, 17 percent had severe hypoglycemia compared to just 4 percent of those on standard insulin therapy.