not going there tiger... even though my background IS research molecular biology, with an emphasis on immunology.... suffice to say i don't agree with Brian 110% and would love to see specific definitive references.....i agree with MOST of Brian's points right down the line, (especially the PRIMARY reason for giving steroids in sepsis and that dex is NOT the agent of choice) others, not so much.... no time to look it up myself AND we're coming at it from slightly different angles to begin with....
my ENTIRE point was that empiric dex probably would not hurt anything, but that it was not high upon the "to-do" list....poor Dave muddled things by first lumping CNS and Sepsis together, then separating them....we've sidebarred this more than long enough...my apologies to Jason and CONGRATS again on the beautiful boy!
Hey...I didn't start this part of the thread....Just responding for those reading these posts...I'm just clarifying statements that were made related to steriods in sepsis for suppression of inflammation.
There is no doubt that steriods can provide anti-inflammatory effects in certain disease processes...for example, Asthma and COPD. Regarding sepsis, the literature is quite evident that steriod use is indicated for replacement in the suspected or proven adrenally insufficient patient, which is primarily indicated setting of septic shock/refractory hypotension....it's the only indication in the setting of sepsis. With the overwhelming SIRS response, there is no way anyone will suppress the inflammatory response with steriods unless a big enugh dose is given that will unfortunately suppress the immune system and potentially kill the patient. This was recognized long before I was born. I've personally never read any literature that supports administration of corticosteriods for its anti-inflammatory effects in the setting of sepsis...and it's not routine clinical practice....at least where my NP experience is in both NC (CLT and Greenville) and Philadelphia at PENN.
Tex...you're right.....APC is the primary drug used for its anti-inflammatory effects as well as its other effects on coagulation, etc...Again, not a standard drug to give for all septic patients...very specific criteria for its use (ie: 2 or more organ system failures, APACHE score > 25, etc). But I've seen dramatic clinical improvement with its use.