Corticosteroids have been used for decades in the adjunctive treatment of severe infections in intensive care. The most frequent scenario in intensive care is in septic shock, where low doses of glucocorticoids appear to restore vascular responsiveness to norepinephrine. There is a strong body of evidence suggesting that hydrocortisone reduces time on vasopressor, and may modulate the immune response. In this review, we explore the current evidence supporting the use of corticosteroids in septic shock, its benefits, and potential harms. In addition to landmark clinical trials, we will also describe new frontiers for the use of corticosteroids in septic shock which should be explored in future studies.

几十年来，皮质类固醇已被用于重症监护中严重感染的辅助治疗。重症监护中最常见的情况是感染性休克，此时低剂量的糖皮质激素似乎可以恢复血管对去甲肾上腺素的反应性。有大量证据表明氢化可的松可减少使用升压药的时间，并可能调节免疫反应。在这篇综述中，我们探讨了当前支持在感染性休克中使用皮质类固醇的证据、其益处和潜在危害。除了具有里程碑意义的临床试验外，我们还将描述在感染性休克中使用皮质类固醇的新领域，这些领域应在未来的研究中进行探索。