Faut-il toujours utiliser les corticoïdes dans le choc septique ?

The hypothalamo-pituitary adrenal axis (HPA) appears to play the most important role in the regulation of inflammation during septic shock. Many factors modulate this axis. Therapeutic issues in critically ill patients still remain controversial and ardently debated, especially with regard to the practical use of corticosteroids in septic shock. The mechanisms and definitions of corticosteroids insufficiency in sepsis are summarized, as well as the main mechanisms of action of corticosteroids. The favourable effects of corticosteroids on hemodynamic and immune homeostasis during septic shock have been demonstrated in a number of experimental and in clinical studies. A systematic review of randomized controlled trials also suggested that moderate dose of corticosteroids (200 to 300 mg per day of hydrocortisone) given for at least 5 days at full dose are associated with improved 28-day and hospital all cause mortality, improved reversal of shock and ICU length of stay without major adverse events except metabolic complications, mainly hyperglycemia and hypernatremia.