Sepsis & septic shock · Steroids in septic shock
Adjunctive Glucocorticoid Therapy in Patients with Septic Shock
| Design | International, multicentre, double-blind randomised controlled trial |
|---|---|
| Treatment | Continuous infusion of hydrocortisone 200 mg daily for 7 days |
| Control | Placebo |
| Population | 3658 patients with septic shock undergoing mechanical ventilation |
| Follow-up | 90 days |
| Primary endpoint | All-cause mortality at 90 days |
| Result | Continuous hydrocortisone infusion did not reduce 90-day mortality compared with placebo among 1832 and 1826 patients respectively. Shock resolved faster and duration of initial ventilation was shorter with hydrocortisone. |
| Secondary endpoints | Time to shock resolution, duration of ventilation, ICU length of stay, transfusion |
Among patients with septic shock undergoing mechanical ventilation, a continuous infusion of hydrocortisone did not result in lower 90-day mortality than placebo.
The trial authors, in the published abstract
Published in the same issue as APROCCHSS, which reached the opposite conclusion. The differences — fludrocortisone, bolus versus infusion, and a sicker French population — are the whole debate, and neither trial settles it. Most units now give steroids to patients on escalating vasopressors and accept the uncertainty.
Venkatesh B, Finfer S, Cohen J, et al. Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. N Engl J Med 2018 Mar 1;378(9):797-808.