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The idea that low-dose corticosteroids might improve outcomes in patients with septic shock is making a comeback: Interest has been fueled by observations that many critically ill patients appear to have impaired adrenal reserve. In a double-blind study, French researchers randomized 300 patients with septic shock to receive 7-day courses of hydrocortisone (50 mg intravenously every 6 hours) plus fludrocortisone (50-µg tablet once daily), or placebo. The patients all had strongly suspected or documented infection, hypotension, need for mechanical ventilation, and several other indicators of organ dysfunction. All patients underwent short corticotropin stimulation tests before they started steroid therapy.
Among the 229 patients who did not r…