High-Dose Steroids and Sepsis

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To the Editor: Both clinical investigators studying steroids and doctors working in intensive care units hoped that the two multi-center trials (Sept. 10 issue)1 , 2 would provide a conclusive answer in the controversy over high-dose glucocorticosteroid therapy for patients with systemic sepsis and septic shock. Unfortunately, this expectation was not fulfilled, and the steroid story continues.Study designers should learn from the failures and criticisms of previous studies.3 4 5 Those who designed the Veterans Administration trial undeniably did so,1 but such learning was only limited in the design of the trial by Bone et al.2 Serious drawbacks and too many open questions . . .