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Low‐dose hydrocortisone treatment for patients with septic shock: A pilot study comparing 3 days with 7 days
Author(s) -
HUH JIN WON,
CHOI HYESOOK,
LIM CHAEMAN,
KOH YOUNSUCK,
OH YEON MOK,
SHIM TAE SUN,
LEE SANG DO,
KIM WOO SUNG,
KIM DONG SOON,
HONG SANGBUM
Publication year - 2011
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/j.1440-1843.2011.02018.x
Subject(s) - medicine , septic shock , adrenal insufficiency , hydrocortisone , shock (circulatory) , intensive care unit , resuscitation , sepsis , surviving sepsis campaign , clinical endpoint , corticosteroid , anesthesia , intensive care , randomized controlled trial , intensive care medicine , severe sepsis
Background and objective: Although there is controversy regarding the benefit of low‐dose corticosteroid therapy in patients with septic shock, the Surviving Sepsis Campaign has advocated that low‐dose intravenous hydrocortisone be used to treat adult septic shock patients. This study investigated the effect of the duration of a stress dose of hydrocortisone on survival of septic shock patients with relative adrenal insufficiency. Methods: One hundred and thirty consecutive patients who met the American College of Chest Physicians/Society of Critical Care Medicine criteria for septic shock were included in the study. An additional inclusion criterion was vasopressor support after fluid resuscitation. The primary end‐point was 28‐day mortality, and the secondary end‐points were shock reversal and mortality in the intensive care unit and hospital. All eligible patients were prospectively randomized to receive hydrocortisone treatment for 3 or 7 days. Hydrocortisone treatment was started at a dose of 50 mg every 6 h. Results: Baseline data at recruitment did not differ between the two groups. After 28 days, mortality did not differ between the 3‐ and 7‐day treatment groups (33.8% vs 36.9%, P = 0.629). Mortality rates in the intensive care unit and hospital did not differ significantly between the two groups. The median time to withdrawal of vasopressor therapy was 5.0 days in the 3‐day treatment group and 6.4 days in the 7‐day treatment group ( P = 0.102). Conclusions: This pilot study showed that in patients with septic shock and relative adrenal insufficiency, 28‐day mortality did not differ between those treated with low‐dose hydrocortisone for 3 or 7 days.