Updating evidence role corticosteroids severe sepsis septic shock custody and dating
Multiple corticosteroids and treatment regimens have been used as adjuncts in the treatment of septic shock.
Qualitative and quantitative differences exist at cellular and tissular levels between the different drugs and their patterns of delivery.
We performed a network meta-analysis (NMA) on the data used for the Cochrane review to establish the likely effectiveness of each drug and therapeutic regimen in adults with septic shock.
Data from trials of acute respiratory distress syndrome (ARDS) were included when separate data were available for participants with sepsis or when contact with study authors resulted in provision of the data.
However, we excluded all data from children ( Infusions were defined as treatment regimens where there was continuous delivery of a drug without interruption until the end of the treatment period.
Two authors (BG, TM) extracted data and cross-checked this for accuracy against the original publications. Where the treatment regimen was not published, one author (BG) attempted to contact the authors.
If the authors were unable to be contacted, the study was excluded.
Even at dose equivalency, some corticosteroids have more immunosuppressive properties (e.g., dexamethasone), and some have more mineralocorticoid and vasoreactive properties (e.g., hydrocortisone) .
This, tied with the evidence that endogenous glucocorticoids are secreted in a pulsatile manner in health , major surgery  and critical illness  warranted further analysis of the effects of the individual drugs and the dose regimens used.
Studies that included children and were designed to assess respiratory function in pneumonia and acute respiratory distress syndrome, as well as cross-over studies, were excluded.