Retrospective evaluation of dexamethasone for treatment of suspected critical illness-related corticosteroid insufficiency in dogs with septic shock (2017–2022): 60 cases

Abstract

Objective

To retrospectively compare and report vasopressor duration and mortality of septic dogs with hypotension refractory to vasopressor administration (presumed critical illness-related corticosteroid insufficiency [CIRCI]) treated with or without dexamethasone sodium phosphate (DxSP).

Design

Retrospective study (2017–2022).

Setting

Tertiary referral and teaching hospitals.

Animals

Sixty client-owned dogs with confirmed or presumed sepsis and vasopressor-resistant hypotension. Hypotension was defined as systolic arterial pressure < 90 mm Hg or MAP < 65 mm Hg. Vasopressor resistance was defined as hypotension despite therapy with moderate- to high-dose vasopressors (> 0.5 µg/kg/min of norepinephrine IV).

Interventions

None.

Measurements and Main Results

Twenty-six dogs received DxSP (DxSP group, 0.002–0.39 mg/kg IV, variable frequency), and 34 dogs did not receive a glucocorticoid (non-DxSP group). The median time to vasopressor discontinuation was 20 hours (interquartile range [IQR]: 21; n = 6) in the DxSP group and 27 hours (IQR: 11; n = 5) in the non-DxSP group. In the DxSP group, 23% (6/26) of dogs survived to discharge compared with 15% (5/34) of dogs in the non-DxSP group, which was not significantly different (relative risk: 0.90, 95% confidence interval: 0.70–1.16; P = 0.41). There was no significant difference between the 2 groups in time from vasopressor administration to weaning in dogs that survived to discharge (P = 0.43). The median time from steroid administration to vasopressor wean was 15 hours (IQR: 19; n = 6), and the median time from steroid administration to sustained normotension (a systolic blood pressure > 90 mm Hg or a MAP >65 mm Hg for at least 4 h) was 1 hour (IQR: 5; n = 11).

Conclusions

There was no association between DxSP therapy and survival, duration of vasopressor therapy, or time between steroid administration and discontinuation of vasopressor therapy in dogs being treated for sepsis, vasopressor resistance, and suspected CIRCI.