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Guidelines for septic shock therapy recommend the use of hydrocortisone largely on the basis of one well-conducted study in which benefit was seen only in patients who did not respond to a corticotropin test (Journal Watch Emergency Medicine Nov 13 2002). In the current multicenter, randomized, controlled, double-blind study, researchers included a broad population of 499 patients with sepsis who had evidence of shock that persisted for more than 1 hour during the 72 hours before enrollment, despite adequate fluid replacement. Patients received either 50 mg of intravenous hydrocortisone or placebo every 6 hours for 5 days, followed by dose tapering over 6 days.
Rates of death at 28 days (the primary outcome) did not differ between treatment …