@efutier SEPSIS : WHAT’S NEW ? PRO / CON Hémisuccinate d’hydrocortisone Emmanuel FUTIER, MD, PhD Département de Médecine Périopératoire, Anesthésie Réanimation Hôpital Estaing et Hôpital Gabriel Montpied, CHU de Clermont-Ferrand Université Clermont Auvergne, CNRS UMR 6293, INSERM U1103, GReD 25ème ICAR – École de Santé des Armées, Bron 30 Novembre 2018
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PRO / CON Hémisuccinate d’hydrocortisone€¦ · 1976 - 2018 24 RCTs (ou quasi RCTs) 8859 patients inclus 18 méta-analyses
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@efutier
SEPSIS : WHAT’S NEW ?
PRO / CON Hémisuccinate d’hydrocortisone
Emmanuel FUTIER, MD, PhD
Département de Médecine Périopératoire, Anesthésie Réanimation
Hôpital Estaing et Hôpital Gabriel Montpied, CHU de Clermont-Ferrand
Université Clermont Auvergne, CNRS UMR 6293, INSERM U1103, GReD
Primary outcome measure: all cause mortality at 28 days
BMJ. 2004 Aug 28;329(7464):480
Fig 1 Effects of corticosteroids
on all cause mortality at 28
days in patients with severe
sepsis and septic shock
BMJ. 2004 Aug 28;329(7464):480
BMJ. 2004 Aug 28;329(7464):480
Surviving Sepsis Campaign guidelines for management
of severe sepsis and septic shockR. Phillip Dellinger, MD; Jean M. Carlet, MD; Henry Masur, MD; Herwig Gerlach, MD, PhD; Thierry Calandra, MD; Jonathan
Cohen, MD; Juan Gea-Banacloche, MD, PhD; Didier Keh, MD; John C. Marshall, MD; Margaret M. Parker, MD; Graham
Ramsay, MD; Janice L. Zimmerman, MD; Jean-Louis Vincent, MD, PhD; Mitchell M. Levy, MD; for the Surviving Sepsis
Campaign Management Guidelines Committee
Crit Care Med 2004; 32:858 –873
H. Steroids
Intravenous corticosteroids (hydrocortisone 200–300 mg/day, for 7 days
in three or four divided doses or by continuous infusion) are recommended
in patients with septic shock who, despite adequate fluid replacement,
require vasopressor therapy to maintain adequate blood pressure.
Grade C
CORTICUS study
• Multicenter, randomized, double-blind,
placebo-controlled trial
• N=499 patients with septic shock
• Primary endpoint: Rate of death at 28 days in
patients who did not have a response to
corticotropin
N Engl J Med 2008;358:111-24
RR 1.09 (0.84 to 1.41)
Absolute difference 2.8% (−5.5 to 11.2)
RR 1.09 (0.77 to 1.52)
Absolute difference 3.1% (−9.5 to 15.7)
• N=20 trials (2384 patients)
• Primary Outcome: 28-Day All-Cause
• Mortality
• 35.3% vs 38.5%, RR, 0.84; 95% CI,
0.71-1.00; P=.05
Cochrane Database Syst Rev.2011 Mar 16;(3):CD007720
Primary Outcome: 30-Day All-Cause Mortality
Intention-to-Treat Regression analysis: OR 0.75 (0.46 to 1.21), P = .24Clin Infect Dis. 2018; 66(3):346-354