The effect of physiologic dose of intravenous hydrocortisone in patients with refractory septic shock: a randomized control trial

Objective: Septic shock is a response to infection and tissue hypoperfusion which does not respond to fluid therapy and eventually leads to organ dysfunction. Aggressive treatment of a broad-spectrum antimicrobial and supportive measures are the cornerstones of successful treatment. In addition to the main treatment, there are adjunctive therapies. Steroids are one of the treatments which have been studied in the management of refractory septic shock. Despite numerous studies on the role of steroids in the mortality of severe sepsis and septic shock, still lots of controversies exist. These conflicts are often about the steroid dose and duration of administration.Methods: This was a prospective, randomized-controlled, two-group assignment study. Patients referred to Imam Reza (AS) hospital in Mashhad who had refractory septic shock criteria were randomly divided into two groups: ۸۰ patients were included in each group. After obtaining the baseline cortisol level and cosyntropin test, one group was treated with intravenous hydrocortisone, and the other group was treated with placebo. The response to hydrocortisone, the return of shock duration, and mortality at ۲۸ days were investigated. The data were analyzed using SPSS version ۱۶. For the normally distributed variables, a t test was used for comparisons. Concerning qualitative variables, the chi-square test or Fisher exact test were applied accordingly.Results: The return of shock duration and mortality in intervention group patients was more than control group, but it was not statistically significant.Conclusion: Despite numerous studies in this field, there are various outcomes (mortality rate, rate of return of shock, time of return of shock). These differences can be attributed to high degree of heterogeneity. Perhaps considering the underlying disease and more differentiation could change the return of shock and mortality rate.

Keywords:

Hydrocortisone , Septic shock , Adrenal insufficiency , cortisol