Starting Hydrocortisone at Time of Pressor Initiation Is Not Helpful for Septic Shock

Current guidelines recommend low-dose hydrocortisone only for fluid- and vasopressor-refractory septic shock (NEJM JW Emerg Med Mar 2017 and Intensive Care Med 2017; 43:304). Speculating that earlier initiation of hydrocortisone therapy might improve outcomes, investigators in China randomized 118 patients with septic shock to receive hydrocortisone (200 mg per day by continuous infusion for 6 days, then tapered off) or placebo at the time of vasopressor initiation. Patients were enrolled within 6 hours of onset of septic shock.

There were no significant differences between groups in mortality, proportion of patients with reversal of shock, or length of stay in the intensive care unit or hospital.