Updating evidence role corticosteroids severe sepsis septic shock updating a blackberry pearl

Bayesian outcome probabilities were calculated as the probability (P) that OR ≥1. High-dose (1000 mg hydrocortisone (equivalent) per day) corticosteroid trials were associated with a null (n = 5; OR 0.91(0.31-1.25)) or higher (n = 4, OR 1.46(0.73-2.16), outlier excluded) mortality probability (P = 42.0% and 89.3%, respectively).This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers.It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

The elderly are predisposed to sepsis due to co-existing co-morbidities, repeated and prolonged hospitalizations, reduced immunity, functional limitations and above all due to the effects of aging itself.

A lower threshold and a higher index of suspicion is required to diagnose sepsis in this patient population because the initial clinical picture may be ambiguous, and aging increases the risk of a sudden deterioration in sepsis to severe sepsis and septic shock.

In recent years, the incidence of elderly patients being admitted to intensive care units (ICUs) has increased globally[1].

This process of “demographic transition” can be explained not only by a decrease in fertility, and hence birth rate, but also by a decline in mortality rates leading to increased life expectancy.

We have also tried to identify the areas for future investigations that might improve outcomes in this particular patient population.

Sepsis is defined as an inflammatory body response to infection, with severe sepsis and septic shock being its more severe forms[3].

Indeed, the time to initiate therapy is thought to be crucial and the major determent factor in surviving sepsis.

Despite substantial progress in sepsis therapy, the gap between the discovery of new effective medical molecules and their implementation in the daily clinical practice of the intensive care unit remains a major hurdle.

Management is largely based on standard international guidelines with a few modifications.

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