The majority of respondents (78%) elected to treat with hydrocortisone, with around 10% each selecting the alternatives.
The series editors (Finfer and Vincent), supported the use of steroids with significant caveats. Referring to the 2012 Surviving Sepsis Guidelines the editors point out that the use of steroids is only supported where hypotension is refractory to adequate fluid resuscitation and inotropes. The level of evidence supporting the use of steroids in this context is not strong (Level 2C), but is stronger than that supporting the use of either IVIG or statins.
The accompanying review of “Severe Sepsis and Septic Shock” can be found here and provides a good overview of the pathophysiology involved, the recommendations of the surviving sepsis campaign, and the search for new treatments. Again, this editorial is written by critical care experts (Derek Angus and Tom van der Poll) and is well worth reading.
Thanks to all of you who voted!