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Updating evidence role corticosteroids severe sepsis septic shock

In recent years, the incidence of elderly patients being admitted to intensive care units (ICUs) has increased globally[1].

This process of “demographic transition” can be explained not only by a decrease in fertility, and hence birth rate, but also by a decline in mortality rates leading to increased life expectancy.

Management is largely based on standard international guidelines with a few modifications.

Age itself is an independent risk factor for death in patients with severe sepsis, however, many patients respond well to timely and appropriate interventions.

Fortunately, ongoing research continues to provide new information on the management of sepsis, in particular, severe sepsis or septic shock.

High quality and effective management tools are necessary to bring evidence-based therapy to the bedside.

Bayesian outcome probabilities were calculated as the probability (P) that OR ≥1. High-dose (1000 mg hydrocortisone (equivalent) per day) corticosteroid trials were associated with a null (n = 5; OR 0.91(0.31-1.25)) or higher (n = 4, OR 1.46(0.73-2.16), outlier excluded) mortality probability (P = 42.0% and 89.3%, respectively).

This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers.

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Future investigations in the management of sepsis should not only target good functional recovery but also ensure social independence and quality of life after ICU discharge.Despite advances in the management of septic patients, sepsis is still the second leading cause of death among patients in non-coronary ICUs[4].The incidence and prevalence of sepsis increase with age[5].Indeed, we need to revisit current paradigms and to think about the possibility that outcome may be predetermined in severe sepsis or septic shock.In addition, an early diagnosis of sepsis prior to the onset of clinical decline is also of particular interest to health practitioners because this information increases the possibilities for early and specific treatment of this life threatening condition.The elderly are predisposed to sepsis due to co-existing co-morbidities, repeated and prolonged hospitalizations, reduced immunity, functional limitations and above all due to the effects of aging itself.A lower threshold and a higher index of suspicion is required to diagnose sepsis in this patient population because the initial clinical picture may be ambiguous, and aging increases the risk of a sudden deterioration in sepsis to severe sepsis and septic shock.Indeed, the time to initiate therapy is thought to be crucial and the major determent factor in surviving sepsis.Despite substantial progress in sepsis therapy, the gap between the discovery of new effective medical molecules and their implementation in the daily clinical practice of the intensive care unit remains a major hurdle.It has been predicted that in the near future, the elderly will grow more rapidly than any other age group, and by 2050 the world’s elderly population will exceed that of the young for the first time in history[2].Sepsis is an important cause of morbidity and mortality in the older population.

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  1. Moran, J L et al. Updating the evidence for the role of corticosteroids in severe sepsis and septic shock a Bayesian meta-analytic perspective. C.

  2. Corticosteroids in the treatment of severe sepsis and septic shock in. Updating the evidence for the role of corticosteroids in severe sepsis and septic.

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