Esteroides, sepsis y shock séptico: de la plausibilidad biológica a la evidencia actual. Revisión narrativa

Abstract

The discovery of steroids marked a medical milestone, both physiologically, by understanding adrenal function; and therapeutically, by finding an anti-inflammatory and immunosuppressive hormone that changed the natural history of autoimmune diseases.

Sepsis is systemic inflammation secondary to an infection, therefore, the use of steroids is biologically plausible. However, history provides negative data on their use at high doses (immunosuppression). Low doses activate non-genomic mechanisms with immunomodulatory and neuroendocrine responses that restore adrenergic sensitivity and improve the hemodynamic context in patients with septic shock and have opened a path towards a reasonable and supported therapeutic indication.

The objective of this review is to trace the historical path of steroids from their discovery to their current indication in septic shock.