Numerous studies have been performed to determine whether corticosteroids are of value in the treatment of shock. Outstanding are those of Spink,1 Lillehei,2 Weil,3 and Fine,4 describing the salutary effect of corticosteroids in endotoxic and cardiogenic shock. Cavanagh5 has reported corticosteroid therapy to be effective for septic shock in obstetrical and gynecologic patients. Other investigators,6,7 however, have warned against the use of this hormone in shock because a hemodynamic rationale has not yet been established. Our recent studies in Macaca rhesus monkeys in hypovolemic shock showed that corticosteroids increased microcirculatory perfusion in the omentum and mesentery. Associated with increased perfusion was a decrease in serum metabolites, lactic acid, amino acids, and phosphates.8 It was the purpose of the present study to determine whether there is a metabolic rationale for the use of corticosteroids in hypovolemic shock in humans.
Methods
Fifty patients in hemorrhagic