Corticosteroids in Septic Shock with Dr. Jerry Zimmerman Part 1
Aug 14, 2023
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Dr. Jerry Zimmerman, Professor of Pediatrics at the University of Washington and former Chief of the Division of Critical Care Medicine, discusses the use of corticosteroids in septic shock. Topics include the physiologic rationale, clinical evidence, current practice patterns, side effects, and future research. The chapter also highlights the significance of perseverance, teamwork, learning, and addressing burnout in pediatric intensive care.
Children with endotype A, characterized by downregulation of adaptive immune response, have a higher risk of mortality in septic shock, caution should be exercised when administering corticosteroids to these children.
The effectiveness of corticosteroids in septic shock is still unclear, with conflicting evidence from adult and pediatric studies, particularly regarding the use of hydrocortisone versus other corticosteroids.
Deep dives
Risk factors associated with poor outcomes in pediatric patients with endotype A
Children with endotype A, characterized by downregulation of adaptive immune response, glucocorticoid receptors, and nitric oxide metabolism, have a higher risk of mortality and longer ICU stay. Administering corticosteroids to these children increases the risk of mortality by fourfold.
Dr. Zimmerman's career advice and key mentors
Dr. Zimmerman emphasizes the importance of getting involved in national critical care organizations, such as the Society of Critical Care Medicine. He highlights the value of mentorship from influential figures in his own career and suggests that engaging in research and other activities outside of clinical care can prevent burnout.
Mixed evidence on the use of steroids in septic shock
The evidence on the effectiveness of steroids in septic shock is still unclear. While some adult studies suggest potential benefits in terms of resolution of organ dysfunction, multiple trials have shown no improvement in mortality. Observational studies in pediatric patients have also failed to demonstrate significant benefits.
Different corticosteroids and their effectiveness
While hydrocortisone has been the main corticosteroid studied in septic shock, the evidence supporting its use is limited. Methylprednisolone and dexamethasone have not been studied as extensively, and their efficacy in septic shock remains uncertain.
Jerry Zimmerman, M.D, PhD, FCCM is a Professor of Pediatrics at the University of Washington and the former Chief of the Division of Critical Care Medicine and the Director of the Pediatric Intensive Care Unit at Seattle Children’s Hospital. He is a past president of the Society of Critical Care Medicine. Dr. Zimmerman is the co-editor of the textbook Pediatric Critical Care and is an accomplished researcher. He was a charter principal investigator in the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) network and is a co-principal investigator for the Stress Hydrocortisone in Pediatric Septic Shock (SHIPSS) trial that we will discuss later in this episode.
Learning Objectives:
By the end of this podcast, listeners should be able to discuss:
The physiologic rationale supporting and opposing the use of corticosteroids in septic shock.
The high-quality clinical evidence supporting and opposing the use of corticosteroids in septic shock.
The current practice patterns among pediatric intensivists in prescribing corticosteroids in septic shock.
The clinically relevant side effects associated with corticosteroids in septic shock.
Future research of corticosteroids in septic shock with emphasis on the Stress Hydrocortisone in Pediatric Septic Shock (SHIPSS) study.
Key reference:
Zimmerman, Jerry J. MD, PhD, FCCM. A history of adjunctive glucocorticoid treatment for pediatric sepsis: Moving beyond steroid pulp fiction toward evidence-based medicine. Pediatric Critical Care Medicine: November 2007 - Volume 8 - Issue 6 - p 530-539
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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.comfor detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
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