CORTICOSTEROIDS IN HYPOVOLEMIC SHOCK

The Vast majority of studies on the efficacy of corticosteroids in hyp ovolemic shock (HVS) have been experimental. Because of this lack of c linical studies, it is necessary to determine whether experimental fin dings are relevant in clinical: patients with HVS. This article review s original experimental studies advocating the use of corticosteroids in HVS, many of which involved pretreating the animal with corticoster oids, had poor experimental designs, or did not provide ancillary trea tment with intravenous fluids. The proposed mechanisms of action of co rticosteroids, including cardiac and vascular effects, membrane stabil ization, and metabolic effects, are reviewed along with corticosteroid toxicity. The adverse effects associated with corticosteroid administ ration include gastric ulceration and bleeding, induced hyperglycemia, delayed healing, and immune suppression. The beneficial effects attri buted to using corticosteroids in shock patients include improved surv ival, stabilization of membranes, augmentation of cardiac output, vaso dilation, and improved tissue metabolism. However, some studies report that corticosteroids increase survival by a few hours or days and oth ers report increased blood pressure, cardiac output, or other changes. Based on insufficient evidence to support a clearly beneficial role o f corticosteroids in HVS and the potential adverse effects, it is time to reconsider the use of corticosteroids in these patients.