Treatment
In adults with septic shock and refractory hypotension despite resuscitation with intravenous fluids and vasopressors, hydrocortisone is the preferred corticosteroid. It can be divided in several doses or administered as a continuous infusion. Fludrocortisone is optional in CIRCI, and dexamethasone is not recommended. Little evidence is available to judge when and how corticosteroid therapy should be stopped; guidelines recommend tapering corticosteroids when vasopressors are no longer needed.
Corticosteroid treatment has also been suggested as an early treatment option in patient with acute respiratory distress syndrome. Steroids have not been shown beneficial for sepsis alone. Historically, higher doses of steroids were given, but these have been suggested to be harmful compared to the lower doses which are advocated today.
In the CORTICUS study, hydrocortisone hastened the reversal of septic shock, but did not influence mortality, with an increased occurrence of septic shock relapse and hypernatremia. The latter findings tempered enthusiasm for the broad use of hydrocortisone in septic shock. Prior to this study, several other smaller studies showed beneficial effects of long courses of low doses of corticoid. Several factors (such as lack of statistical power due to slow recruitment) could have led a false-negative finding on mortality in the CORTICUS study; thus, more research is needed.
Read more about this topic: Critical Illness-related Corticosteroid Insufficiency
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—C. John Sommerville (20th century)
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—Margaret Mead (1901–1978)