@article{3f64b0e3f9e543ac9f1fcb430b6be104,
title = "Efficacy and safety of low-dose hydrocortisone therapy in the treatment of septic shock",
abstract = "Objective: To evaluate the efficacy and safety of low-dose hydrocortisone therapy in patients with septic shock. Design: Multicentre, randomized, double-blind, placebocontrolled trial. Setting: Nine centres (including 52 in - tensive care units) in Europe and the Middle East. Patients: Patients with clinical evidence of infection, evidence of systemic response to infection and onset of shock within the previous 72 hours (defined by systolic blood pressure < 90 mm Hg despite adequate fluid replacement or a need for vasopressors for at least 1 hour) and hypo - perfusion or organ dysfunction attributable to sepsis. Intervention: Intervention group (n = 251) was randomly assigned to receive 50 mg of hydrocortisone intravenously, and the control group (n = 248) was randomly assigned to receive placebo every 6 hours for 5 days; the dose was tapered during a 6-day period. Main outcome measure: Death at 28 days in patients who did not have a response to corticotrophin. Results: In all, 233 (46.7%) patients did not have a response to corticotrophin (125 in the treatment group and 108 in the placebo group). At 28 days, there was no significant difference in mortality between patients in the 2 groups who did not have a response to corticotropin (39.2% in the treatment group and 36.1% in the placebo group, p = 0.69) or between those who had a response to corticotropin (28.8% in the treatment group and 28.7% in the placebo group, p = 1.00). At 28 days, 86 of 251 (34.3%) patients in the treatment group and 78 of 248 (31.5%) in the placebo group had died (p = 0.51). In the treatment group, shock was reversed more quickly than in the placebo group. How ever, there were more episodes of superinfection, including new sepsis and septic shock. Conclusion: Hydrocortisone cannot be recommended as general adjuvant therapy for septic shock (vasopressor responsive), nor can corticotrophin testing be recommended to determine which patients should receive hydrocortisone therapy.",
author = "Prosanto Chaudhury and Marshall, {John C.} and Solomkin, {Joseph S.} and Baxter, {N. N.} and Brasel, {K. J.} and Brown, {C. J.} and Cutter, {C. S.} and Divino, {C. M.} and E. Dixon and L. Dubois and Fitzgerald, {G. W.N.} and Henteleff, {H. J.A.} and Kirkpatrick, {A. W.} and S. Latosinsky and MacLean, {A. R.} and Mastracci, {T. M.} and McLeod, {R. S.} and Morris, {A. M.} and Neumayer, {L. A.} and Temple, {L. K.} and McKenzie, {M. E.}",
note = "Funding Information: Evidence Based Reviews in Surgery (EBRS) is a program jointly sponsored by the Canadian Association of General Surgeons (CAGS) and the American College of Surgeons (ACS) and is supported by an educational grant from ETHICON and ETHICON ENDO-SURGERY, both units of Johnson & Johnson Medical Products, a division of Johnson & Johnson and ETHICON Inc. and ETHICON ENDO-SURGERY Inc., divisions of Johnson & Johnson Inc. The primary objective of EBRS is to help practising surgeons improve their critical appraisal skills. During the academic year, 8 clinical articles are chosen for review and discussion. They are selected for their clinical relevance to general surgeons and because they cover a spectrum of issues important to surgeons, including causation or risk factors for disease, natural history or prognosis of disease, how to quantify disease, diagnostic tests, early diagnosis and the effectiveness of treatment. A methodological article guides the reader in critical appraisal of the clinical article. Methodological and clinical reviews of the article are performed by experts in the relevant areas and posted on the EBRS website, where they are archived indefinitely. In addition, a listserv allows participants to discuss the monthly article. Surgeons who participate in the monthly packages can obtain Royal College of Physicians and Surgeons of Canada Maintenance of Certification credits and/or continuing medical education credits for the current article only by reading the monthly articles, participating in the listserv discussion, reading the methodological and clinical reviews and completing the monthly online evaluation and multiple choice questions. ",
year = "2010",
month = dec,
day = "1",
language = "English (US)",
volume = "53",
pages = "415--417",
journal = "Canadian Journal of Surgery",
issn = "0008-428X",
publisher = "Canadian Medical Association",
number = "6",
}