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Steroid Therapy

Steroid Therapy. Steroid Therapy: The French multi-center RCT. (hypotension despite fluid resuscitation and vasopressors).

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Steroid Therapy

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  1. Steroid Therapy

  2. Steroid Therapy: The French multi-center RCT (hypotension despite fluid resuscitation and vasopressors) 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.

  3. Conclusion Significant shock reversal and reduction of mortality rate in patients with relative adrenal insufficiency (defined as post-adrenocorticotropic hormone (ACTH) cortisol increase 9 µg/dL or less)

  4. Corticosteroid Therapy of SepticShock CORTICUS European multi-center RCT

  5. Hydrocortisone Therapy for Patients with Septic Shock Charles L. Sprung, M.D., Djillali Annane, M.D., Ph.D., Didier Keh, M.D., Rui Moreno, M.D., Ph.D., Mervyn Singer, M.D., F.R.C.P., Klaus Freivogel, Ph.D., Yoram G. Weiss, M.D., Julie Benbenishty, R.N., Armin Kalenka, M.D., Helmuth Forst, M.D., Ph.D., Pierre-Francois Laterre, M.D., Konrad Reinhart, M.D., Brian H. Cuthbertson, M.D., Didier Payen, M.D., Ph.D., Josef Briegel, M.D., Ph.D., for the CORTICUS Study Group N Engl J Med Volume 358(2):111-124 January 10, 2008

  6. Kaplan-Meier Curves for Survival at 28 Days

  7. Conclusion • Hydrocortisone did not improve survival or reversal of shock in patients with septic shock, either overall or in patients who did not have a response to corticotropin, although hydrocortisone hastened reversal of shock in patients in whom shock was reversed

  8. Annane vs Sprung

  9. Streoid Therapy • Consider intravenous hydrocortisone for adult septic shock when hypotension remains poorly responsive to adequate fluid resuscitation and vasopressors. (2C) • ACTH stimulation test is not recommended to identify the subset of adults with septic shock who should receive hydrocortisone. (2B) • Hydrocortisone is preferred to dexamethasone. (2B) • Fludrocortisone (50µg orally once a day) may be included if an alternative to hydrocortisone is being used which lacks significant mineralocorticoid activity. Fludrocortisone is optional if hydrocortisone is used. (2C) • Steroid therapy may be weaned once vasopressors are no longer required. (2D) • Hydrocortisone dose should be ≤300 mg/day. (1A) • Do not use corticosteroids to treat sepsis in the absence of shock unless the patient’s endocrine or corticosteroid history warrants it. (1D)

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