Updating evidence role corticosteroids severe sepsis septic shock
 The complex pathophysiologic changes that take place in severe sepsis have an important impact on endocrine organs and impairment of thyroid, pancreatic and hypophysis-pituitary-adrenal (HPA) functions is well documented.
Length of ICU stay: −1.30 days (95% CI (−3.04)−0.44). Even though CIRCI should be suspected in hypotensive patients who do not respond to fluid and vasopressor agents, especially in the context of sepsis, its diagnosis and management remain a topic of intense controversy.[2,5,6] Glucocorticosteroids have been extensively studied as an adjunctive therapy in septic patients for the past 50 years, initially as high dose (30mg/kg methylprednisolone)  and later as low dose (50mg hydrocortisone every 6 hours) treatment.Animal studies reveal that high chloride solutions cause renal afferent vasoconstriction, which may be the underlying mechanism.
Caution must be taken when LR is used in patients with hyperkalemia or cirrhosis.Despite the development of new effective antimicrobial therapies, source control techniques and aggressive cardiovascular support, septic shock remains one of the most common causes of death in the Intensive Care Unit (ICU).