Steroids for Septic Shock
exp date isn't null, but text field is
Initial Order:
- Hydrocortisone: Hydrocortisone 50 mg IV stat
- Fludrocortisone: 50 mcg PO qAM
Second Order: Choose one
- Hydrocortisone 50 mg IV q6h x 7 days or until ICU discharge
- Hydrocortisone Continuous infusion 8.33 mg/hr x 7 days or until ICU discharge
Surviving Sepsis Campaign Guidelines: “We suggest against using IV hydrocortisone to treat septic shock patients if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability. If this is not achievable, we suggest IV hydrocortisone at a dose of 200 mg per day (weak recommendation, low quality of evidence).”
APROCCHSS Trial: Annane D et al. Hydrocortisone plus Fludrocortisone for Adults with Septic Shock. NEJM 2018; 378: 809-818. DOI: 10.1056/NEJMoa1705716
Inclusion criteria: Vasopressor therapy for at least 6 hours to maintain SBP of at least 90mmHg or a mean blood pressure of 65mmHg (n=1241 patients).
Treatment: Hydrocortisone 50mg IV bolus every 6 hours for 7 days without tapering.
Fludrocortisone 50 mcg tablet once in the morning
ADRENAL Trial: Venkatesh B. et al. Adjunctive Corticosteroid Treatment in Critically Ill Patients with Septic Shock, N Engl J Med 2018; 378:797-808, DOI: 10.1056/NEJMoa1705835
Inclusion criteria: Adult patients with septic shock requiring vasopressors & mechanical ventilation (n=3658 patients)
- Documented or strong suspicion of infection; 2 of the 4 SIRS criteria
- Mechanical ventilation, including non-invasive ventilation (CPAP, bilevel)
- Vasopressors/inotropes for ≥4 hours to maintain systolic BP >90mmHg, or MAP >60mmHg, or a MAP target set by treating physician
Treatment: Hydrocortisone infusion 200mg/day as continuous infusion for 7 days or until ICU discharge
