Corticosteroid therapy for sepsis: a clinical practice guideline

doi:10.1136/bmj.k3284

Practice Guideline

. 2018 Aug 10:362:k3284.

doi: 10.1136/bmj.k3284.

Corticosteroid therapy for sepsis: a clinical practice guideline

Francois Lamontagne^{1

2}, Bram Rochwerg^{3

4}, Lyubov Lytvyn⁴, Gordon H Guyatt⁴, Morten Hylander Møller⁵, Djillali Annane⁶, Michelle E Kho⁷, Neill K J Adhikari^{8

9}, Flavia Machado^{10

11}, Per O Vandvik^{12

13}, Peter Dodek¹⁴, Rebecca Leboeuf¹⁵, Matthias Briel^{4

16}, Madiha Hashmi¹⁷, Julie Camsooksai¹⁸, Manu Shankar-Hari^{19

20}, Mahder Kinfe Baraki²¹, Karie Fugate²², Shunjie Chua²³, Christophe Marti²⁴, Dian Cohen²⁵, Edouard Botton²⁶, Thomas Agoritsas^{4

27}, Reed A C Siemieniuk²⁸

Affiliations

¹ Department of Medicine, Université de Sherbrooke, Sherbrooke, Canada.
² Centre de recherche du CHU de Sherbrooke, Centre intégré universitaire de santé et de services sociaux - Estrie, Sherbrooke, Canada.
³ Department of Medicine, McMaster University, Hamilton, Canada.
⁴ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
⁵ Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
⁶ Service de Médecine Intensive et Réanimation, Hôpital Raymond Poincaré, Garches, France.
⁷ School of Rehabilitation Science, McMaster University, Hamilton, Canada.
⁸ Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto Canada.
⁹ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
¹⁰ Federal University of Sao Paulo, Sao Paulo, Brazil.
¹¹ Latin America Sepsis Institute, Sao Paulo, Brazil.
¹² Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
¹³ Department of Medicine, Innlandet Hospital Trust-division, Gjøvik, Norway.
¹⁴ Center for Health Evaluation and Outcome Sciences and Division of Critical Care Medicine, St Paul's Hospital and University of British Columbia, Vancouver, Canada.
¹⁵ Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.
¹⁶ Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
¹⁷ Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan.
¹⁸ Poole Hospital NHS Foundation Trust, Dorset, United Kingdom.
¹⁹ Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
²⁰ NIHR Clinician Scientist, School of Immunology & Microbial Sciences, Kings College London, United Kingdom.
²¹ Department of Anesthesiology, Addis Ababa University, Addis Ababa, Ethiopia.
²² Renton, USA.
²³ Carevise Mexico, Mexico City, Mexico.
²⁴ Division of General Internal Medicine, Rehabilitation and Geriatrics, University Hospitals of Geneva, Geneva, Switzerland.
²⁵ Centre de santé de la vallée Massawippi, Ayer's Cliff, Canada.
²⁶ Comité stratégique patient-partenaire, Centre de recherche du CHU de Sherbrooke, Centre intégré universitaire de santé et de services sociaux - Estrie, Sherbrooke, Canada.
²⁷ Division General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland.
²⁸ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada reed.siemieniuk@medportal.ca.

PMID: 30097460
PMCID: PMC6083439
DOI: 10.1136/bmj.k3284

Practice Guideline

Corticosteroid therapy for sepsis: a clinical practice guideline

Francois Lamontagne et al. BMJ. 2018.

. 2018 Aug 10:362:k3284.

doi: 10.1136/bmj.k3284.

Authors

Affiliations

¹ Department of Medicine, Université de Sherbrooke, Sherbrooke, Canada.
² Centre de recherche du CHU de Sherbrooke, Centre intégré universitaire de santé et de services sociaux - Estrie, Sherbrooke, Canada.
³ Department of Medicine, McMaster University, Hamilton, Canada.
⁴ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
⁵ Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
⁶ Service de Médecine Intensive et Réanimation, Hôpital Raymond Poincaré, Garches, France.
⁷ School of Rehabilitation Science, McMaster University, Hamilton, Canada.
⁸ Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto Canada.
⁹ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
¹⁰ Federal University of Sao Paulo, Sao Paulo, Brazil.
¹¹ Latin America Sepsis Institute, Sao Paulo, Brazil.
¹² Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
¹³ Department of Medicine, Innlandet Hospital Trust-division, Gjøvik, Norway.
¹⁴ Center for Health Evaluation and Outcome Sciences and Division of Critical Care Medicine, St Paul's Hospital and University of British Columbia, Vancouver, Canada.
¹⁵ Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.
¹⁶ Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
¹⁷ Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan.
¹⁸ Poole Hospital NHS Foundation Trust, Dorset, United Kingdom.
¹⁹ Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
²⁰ NIHR Clinician Scientist, School of Immunology & Microbial Sciences, Kings College London, United Kingdom.
²¹ Department of Anesthesiology, Addis Ababa University, Addis Ababa, Ethiopia.
²² Renton, USA.
²³ Carevise Mexico, Mexico City, Mexico.
²⁴ Division of General Internal Medicine, Rehabilitation and Geriatrics, University Hospitals of Geneva, Geneva, Switzerland.
²⁵ Centre de santé de la vallée Massawippi, Ayer's Cliff, Canada.
²⁶ Comité stratégique patient-partenaire, Centre de recherche du CHU de Sherbrooke, Centre intégré universitaire de santé et de services sociaux - Estrie, Sherbrooke, Canada.
²⁷ Division General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland.
²⁸ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada reed.siemieniuk@medportal.ca.

PMID: 30097460
PMCID: PMC6083439
DOI: 10.1136/bmj.k3284

No abstract available

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the BMJ Rapid Recommendations interests disclosure form, and a detailed description of all disclosures is reported in appendix 2 on bmj.com. As with all BMJ Rapid Recommendations, the executive team and The BMJ judged that no panel member had any financial conflict of interest. Professional and academic interests are minimised as much as possible, while maintaining necessary expertise on the panel to make fully informed decisions.

Figures

**Fig 2**
Characteristics of patients and trials included in systematic review of the use of corticosteroids for treating sepsis CAP = community acquired pneumonia. ARDS = acute respiratory distress syndrome.

**Fig 3**
Practical issues about use of corticosteroids for treatment of sepsis

See this image and copyright information in PMC

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References

1. Venkatesh B, Finfer S, Cohen J, et al. ADRENAL Trial Investigators and the Australian-New Zealand Intensive Care Society Clinical Trials Group Adjunctive glucocorticoid therapy in patients with septic shock. N Engl J Med 2018;378:797-808. 10.1056/NEJMoa1705835 - DOI - PubMed
1. Annane D, Renault A, Brun-Buisson C, et al. CRICS-TRIGGERSEP Network Hydrocortisone plus fludrocortisone for adults with septic shock. N Engl J Med 2018;378:809-18. 10.1056/NEJMoa1705716 - DOI - PubMed
1. Rochwerg B, Oczkowski SJ, Siemieniuk RAC, et al. Corticosteroids in sepsis: an updated systematic review and meta-analysis. Crit Care Med 2018. 10.1097/CCM.0000000000003262 - DOI - PubMed
1. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016;315:801-10. 10.1001/jama.2016.0287 - DOI - PMC - PubMed
1. Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707-10. 10.1007/BF01709751 - DOI - PubMed

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[1] Venkatesh B, Finfer S, Cohen J, et al. ADRENAL Trial Investigators and the Australian-New Zealand Intensive Care Society Clinical Trials Group Adjunctive glucocorticoid therapy in patients with septic shock. N Engl J Med 2018;378:797-808. 10.1056/NEJMoa1705835 - DOI - PubMed

[2] Venkatesh B, Finfer S, Cohen J, et al. ADRENAL Trial Investigators and the Australian-New Zealand Intensive Care Society Clinical Trials Group Adjunctive glucocorticoid therapy in patients with septic shock. N Engl J Med 2018;378:797-808. 10.1056/NEJMoa1705835 - DOI - PubMed

[3] Annane D, Renault A, Brun-Buisson C, et al. CRICS-TRIGGERSEP Network Hydrocortisone plus fludrocortisone for adults with septic shock. N Engl J Med 2018;378:809-18. 10.1056/NEJMoa1705716 - DOI - PubMed

[4] Annane D, Renault A, Brun-Buisson C, et al. CRICS-TRIGGERSEP Network Hydrocortisone plus fludrocortisone for adults with septic shock. N Engl J Med 2018;378:809-18. 10.1056/NEJMoa1705716 - DOI - PubMed

[5] Rochwerg B, Oczkowski SJ, Siemieniuk RAC, et al. Corticosteroids in sepsis: an updated systematic review and meta-analysis. Crit Care Med 2018. 10.1097/CCM.0000000000003262 - DOI - PubMed

[6] Rochwerg B, Oczkowski SJ, Siemieniuk RAC, et al. Corticosteroids in sepsis: an updated systematic review and meta-analysis. Crit Care Med 2018. 10.1097/CCM.0000000000003262 - DOI - PubMed

[7] Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016;315:801-10. 10.1001/jama.2016.0287 - DOI - PMC - PubMed

[8] Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016;315:801-10. 10.1001/jama.2016.0287 - DOI - PMC - PubMed

[9] Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707-10. 10.1007/BF01709751 - DOI - PubMed

[10] Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707-10. 10.1007/BF01709751 - DOI - PubMed

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Corticosteroid therapy for sepsis: a clinical practice guideline

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Corticosteroid therapy for sepsis: a clinical practice guideline

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