The concept of steroids in sepsis has been around for decades. Long before I was a trainee, there was a lot of interest in whether or not the use of high dose steroids to suppress the inflammatory response could be helpful.
Subsequent trials have suggested this might not be the best approach, and lower, "physiological" doses are now proposed.
For a while, there was also a suggestion that we could tailor the use of steroids depending on whether or not the patient was a "responder" or "non-responder" to a synacthen test. The implication was that if you were a non-responder, perhaps your adrenals had already been "exhausted" and a little extra help was required. Nothing came of that either.
Then along came CORTICUS which suggested that at the very least, steroids might improve your responsiveness to vasopressors, and through improved perfusion might prevent end-organ disfunction. However, the tradeoff (high sugars, pro-catabolism, weakness, superinfection) may offset or even overwhelm this benefit.
To find out, Bala Venkatesh and colleagues are conducting the ADRENAL trial. In Noosa this week to update the ANZICS-CTG on the progress of the trial, Bala joined me for this interview.