Critical Care Scenarios Lightning rounds 58: Steroids for septic shock with David Janz
Nov 26, 2025
Dr. David Janz, a pulmonary and critical care intensivist and former director of a critical care Clinical Research Unit, dives deep into the use of steroids for treating septic shock. He explains their mechanisms and how they can act as immune modulators, highlighting the conditions under which they offer the most benefit. Janz discusses critical trials that showcase their effectiveness and the potential risks, such as hyperglycemia and infection. He also shares practical recommendations on dosage and timing, ensuring clarity in a complex area of patient care.
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Five Minutes Or Five Days Debate
- David Janz jokes that steroids warrant either a five‑minute or five‑day discussion due to complexity.
- This highlights how deeply debated steroids are in critical care circles.
Steroids Are Multi‑Mechanism Agents
- Steroids have multiple mechanisms beyond anti-inflammation, including hemodynamic effects that increase vasopressor sensitivity.
- This multi-pronged action explains why steroids may help septic shock beyond just dampening cytokines.
Trial Results Are Context‑Dependent
- Four major randomized trials in septic shock split evenly on mortality benefit.
- Trials that showed survival benefit used fludrocortisone and enrolled sicker patients on higher vasopressors.