- This very small open-label trial found that for patients in septic shock, bolus administration of hydrocortisone led to higher rates of shock reversal vs continuous infusion.
Why this matters
- 60% of patients with septic shock experience relative adrenal insufficiency, a condition linked to worse prognoses.
- The Surviving Sepsis Campaign does not specify whether patients eligible for steroids for septic shock should receive it via bolus or continuous infusion, according to authors.
- Bolus vs continuous group:
- Shock reversal at day 7: 66% (22/33) vs 35% (13/37; P=.008).
- Shock reversal at day 7, excluding early deaths: 75% (22/29) vs 44% (13/29; P=.01).
- 28-day mortality: no difference.
- Single-ICU randomised controlled open-label trial (n=58).
- Adults receiving norepinephrine for septic shock were randomly assigned to receive hydrocortisone 200 mg/day by continuous infusion vs by 50 mg boluses every 6 hours.
- Outcome: shock reversal at day 7.
- Funding: None disclosed.
- Small sample size.
- Inadequate information to assess blood glucose and insulin requirements.