Jorge Luis Vélez-Páez , Daniel Torres-Carpio , Manuel Luis Avellanas-Chavala
{"title":"类固醇,败血症和脓毒症休克:从生物学的合理性到当前的证据。修订故事","authors":"Jorge Luis Vélez-Páez , Daniel Torres-Carpio , Manuel Luis Avellanas-Chavala","doi":"10.1016/j.acci.2025.01.007","DOIUrl":null,"url":null,"abstract":"<div><div>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.</div><div>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.</div><div>The objective of this review is to trace the historical path of steroids from their discovery to their current indication in septic shock.</div></div>","PeriodicalId":100016,"journal":{"name":"Acta Colombiana de Cuidado Intensivo","volume":"25 2","pages":"Pages 361-370"},"PeriodicalIF":0.0000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Esteroides, sepsis y shock séptico: de la plausibilidad biológica a la evidencia actual. Revisión narrativa\",\"authors\":\"Jorge Luis Vélez-Páez , Daniel Torres-Carpio , Manuel Luis Avellanas-Chavala\",\"doi\":\"10.1016/j.acci.2025.01.007\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><div>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.</div><div>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.</div><div>The objective of this review is to trace the historical path of steroids from their discovery to their current indication in septic shock.</div></div>\",\"PeriodicalId\":100016,\"journal\":{\"name\":\"Acta Colombiana de Cuidado Intensivo\",\"volume\":\"25 2\",\"pages\":\"Pages 361-370\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Acta Colombiana de Cuidado Intensivo\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0122726225000072\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta Colombiana de Cuidado Intensivo","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0122726225000072","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Esteroides, sepsis y shock séptico: de la plausibilidad biológica a la evidencia actual. Revisión narrativa
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.