Journal of Nippon Medical School = Nippon Ika Daigaku zasshi
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Review Historical Article
Controversy of corticosteroids in septic shock.
The mortality rate of septic shock remains high. The guidelines of the Surviving Sepsis Campaign were published in 2004 and were revised in 2008. Steroid therapy is prominent in the guidelines but remains controversial. In this review, steroid therapy for septic shock is discussed with various landmark papers.
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The limulus test, which has been established as a test for endotoxin measurement, is associated with problems, including that posed by the presence of a response inhibitor factor and the longer time needed for the measurement of low concentrations. On the other hand, the technique of direct hemoperfusion with a polymyxin B immobilized fiber column (DHP-PMX) was developed in Japan in 1994 and has been used for the control of endotoxemia in septic shock. The limulus test, which is a common endotoxin measurement test, has several problems with regard to sensitivity. ⋯ Here, we describe a patient presenting with colonic perforation who recovered from septic shock with DHP-PMX. This treatment effect was reflected by a decrease in plasma endotoxin levels as demonstrated more readily with endotoxin scattering photometry assay than with the standard limulus test. We conclude that endotoxin measurement with endotoxin scattering photometry is superior to nephelometry in patients with endotoxemia.