October 31, 2016

Background: The most recent surviving sepsis campaign recommends the use of hydrocortisone in patients with refractory septic shock (i.e. vasopressor dependent).  However, the use of hydrocortisone in severe sepsis without shock still remains a very controversial topic. Recommendations for hydrocortisone are mostly based on 2 randomized clinical trials (i.e. Annane et al [2] and CORTICUS [3]), but subsequent meta-analyses had more mixed results.  Shock reversal was consistently improved irrespective of disease severity; however, mortality outcomes were not as consistent.  Therefore, it has been hypothesized that early hydrocortisone administration could prevent shock by attenuating patient’s inflammatory response.