Another Look at Steroids plus Mineralocorticoids for Septic Shock

A large trial showed that hydrocortisone plus fludrocortisone conferred mortality benefit.

In a recently published trial of corticosteroids for treating patients with sepsis and septic shock, hydrocortisone led to more-rapid resolution of shock but no survival benefit (NEJM JW Gen Med Mar 1 2018 and N Engl J Med 2018; 378:797); however, this trial did not include treatment with a mineralocorticoid (e.g., fludrocortisone). Now, in a French trial, 1241 patients with vasopressor-dependent septic shock were randomized to receive either hydrocortisone (50 mg every 6 hours) plus fludrocortisone (50 μg daily) or placebo for 7 days. Most patients (82%) came from medical wards, and more than half had pneumonia. Almost all patients were receiving mechanical ventilation.

Patients treated with hydrocortisone plus fludrocortisone were signific…

Reviewing Author

Patricia Kritek, MD

Disclosures

Editorial BoardsATS Scholar

Patricia Kritek, MD

Disclosures

Editorial BoardsATS Scholar

Another Look at Steroids plus Mineralocorticoids for Septic Shock

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Reviewing Author