Steroid

Steroid in septic shock

The mechanism of action for corticosteroids in septic shock includes mitigation of relative adrenal insufficiency as well as sodium retention and reduction of capillary leakage.

Potential benefits

↓ mortality
↓ organ failure rates
↑ vasopressor-free days
faster resolution of shock & time to discharge from ICU

2021 Surviving Sepsis Campaign suggests intravenous hydrocortisone should be administered as 50 mg intravenous every 6 h or a continuous infusion for a total of 200 mg per day. These guidelines suggest the initiation of corticosteroids when a patient has received a dose of norepinephrine or epinephrine greater than or equal to 0.25 mcg/kg/min for at least 4 h

2024 Critical Care Medicine guideline also recommends administering corticosteroids to adult patients with septic shock

Trials

CORTICUS
APROCCHSS
ADRENAL

References

Corticosteroids in Critically Ill Patients A Narrative Review