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December 1, 2015 by dailybolusoflr
By: Nick Rademacher, MD
Surviving Sepsis Suggestions 1
- Do not use steroids unless refractive to BOTH fluids and vasopressor therapy.
- Vasopressor trial is 60 minutes of nonresponsivness
- If needed give pulse of 200mg IV hydrocortisone
- This recommendation is based on several contradictory studies
- RCT of patients in vasopressor-unresponsive septic shock with significant shock reversal and reduction in mortality.2
- Reproduced in 2 smaller RTCs 3,4
- Large multicenter trial with patients not in sustained shock did not show mortality benefit with steroids 5
- Everyone got steroids, regardless of response to pressors.
Low Dose Steroids
- Results varied based on studies included in systemic reviews.
- With only high quality studies it does not appear low dose steroids offer statistically significantly difference.
- Surviving Sepsis Campaign International Guidelines for Management of Severe Sepsis and Septic Shock: 2012, condensed from Dellinger RP, Levy MM, Rhodes A, et al: Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock. Intensive Care Med 2013; 39(2): 165-228 and Crit Care Med 2013; 41(2): 580-637.
- Annane D, Sébille V, Charpentier C, et al: Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 2002; 288:862–871
- Briegel J, Forst H, Haller M, et al: Stress doses of hydrocortisone reverse hyperdynamic septic shock: A prospective, randomized, double-blind, single-center study. Crit Care Med 1999; 27:723–732, 177.
- Bollaert PE, Charpentier C, Levy B, et al: Reversal of late septic shock with upraphysiologic doses of hydrocortisone. Crit Care Med 1998; 26:645–650
- Sprung CL, Annane D, Keh D, et al; CORTICUS Study Group: Hydrocortisone therapy for patients with septic shock. N Engl J Med 2008; 358:111–124