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For nearly 20 years, clinicians have debated about whether to treat septic shock patients with corticosteroids. In 2018, two large trials added to the debate, because they yielded slightly different results. In one trial (APROCCHSS), 90-day mortality was significantly lower in patients who were treated with both the glucocorticoid hydrocortisone (50 mg every 6 hours for 1 week) and the mineralocorticoid fludrocortisone (50 μg daily) than in placebo recipients (43% vs. 49%). Active-treatment patients also were liberated significantly more quickly from mechanical ventilation and vasopressors (NEJM JW Gen Med Apr 15 2018 and N Engl J Med 2018; 378:809).
In contrast, the other trial (ADRENAL) was a comparison of hydrocortisone alone versus place…