Updating evidence role corticosteroids severe sepsis septic shock
The objective of this study was to elucidate any differences between the drugs and their treatment regimens regarding outcomes for corticosteroid use in adult patients with septic shock.
Network meta-analysis of the data used for the recently conducted Cochrane review was performed.
Complete data from 22 studies and partial data from 1 study were included.
Network meta-analysis provided no clear evidence that any intervention or treatment regimen is better than any other across the spectrum of outcomes.
All analyses were conducted using a frequentist approach assuming a random-effects model, with an equal heterogeneity variance assumed for all comparisons, using the network suite of Stata commands, programmed by Ian White .
We intended to rank the interventions according to their probability to be best, second best, third best and so forth for the different outcomes.
An NMA was undertaken to combine results of all comparisons among interventions in a single analysis.
This approach makes use of both the direct comparisons available within trials and the indirect comparisons of interventions that can be made across trials when they use a common comparator intervention .
Second, do steroids given to all critically ill patients improve outcomes ?
Studies that included children and were designed to assess respiratory function in pneumonia and acute respiratory distress syndrome, as well as cross-over studies, were excluded.
Network plots were created for each outcome, and all analyses were conducted using a frequentist approach assuming a random-effects model.
There was strong evidence of differential efficacy in only one area: shock reversal.
Hydrocortisone boluses and infusions were more likely than methylprednisolone boluses and placebo to result in shock reversal.