The Evolving Understanding of Glucocorticoid Treatment in Septic Shock

There has long been interest in adjunctive therapies in septic shock because this condition continues to carry a significant risk of death and long-term sequelae.1 Adjunctive therapy with glucocorticoids has been the target of many controlled trials in septic shock on the basis of glucocorticoids' multiple putative benefits, including modulation of an excess inflammatory response to infection and treatment of relative adrenal insufficiency due to imbalance in the hypothalamic–pituitary–adrenal axis. Despite this effort, decades of conflicting trial results have left clinicians without consistent guidance about when, and for whom, to implement glucocorticoid therapy.