CURRENT EVIDENCE OF CORTICOSTEROID CHOISE
IN PEDIATRIC SEPSIS
Child Health Department University of Indonesia
Corticosteroids have a role as adjunctive therapy in septic shock through their anti-inflammatory effect of terminating systemic and tissue inflammation. Corticosteroids have been recommended to restore cardiovascular homeostasis only when the patient remain persistently hypotensive despite fluid resuscitation and vasopressor therapy.In the pediatric considerations in the Surviving Sepsis Campaign Guidelines 2012, the timely administration of hydrocortisone was suggested for children with fluid-refractory catecholamine-resistant septic shock and suspected or proven absolute (classic) adrenal insufficiency, which was rated as grade 1A, i.e., strong recommendation with high-quality evidence. The usage of bolus hydrocortisone has been shown to be associated with a 10% absolute reduction in 28-day mortality.
Possible rationales for using corticosteroids in sepsis is adrenal insufficiency. The pediatric literature lacks large RCTs in evaluating the benefit of corticosteroids specifically in septic shock and refractory septic shock, and a pediatric meta-analysis evaluating the role of corticosteroids in shock did not demonstrate benefit. The literature on using steroids in pediatric shock is limited in amount and methodological quality and demonstrates conflicting results. The limited evidence on which current guidelines are based on strongly supports the need for a well-designed, pragmatic randomized controlled trial on using steroids in pediatric shock to inform future guidelines. There has been no study on investigating if the method of hydrocortisone administration shows better outcomes in mortality and length of stay in septic shock.