On stress dose steroid (update from Canada Critical Care Forum meeting)
There was a lot of debate and update particularly in view of results from recent CORTICUS trial. As expected, Dr. Annane, was at center of attraction.
Dr. Annane stand with results of his JAMA 2002 study which showed positive influence of stress dose steroid in septic shock. In his view, CORTICUS trial did not re-produce the same results due to following 3 main reasons:
- Patient population was not as selected to produce same results. Many eligible patients were excluded.
- 72 hours has been allowed to start stress dose steroid in contrast to early start (24 hours) as in 2002 study.
- Fludrocortisone was not added which could have made a significant difference in outcome.
Also, while answering a question - he recommends not to exceed the dose beyond 200 mg per day in divided doses or preferably in continuous drip (to avoid peak sugar levels).
Despite his stand on use of low / stress dose steroid in septic shock - with performing corticotropin test - he expressed his concern about overuse of steroids in septic shock.
Please note that updated guidelines on sepsis from SCCM / ISF recommends use of hydrocortisone if septic shock is unresponsive to pressors. Fludrocortisone as well as corticotropin test is not recommended.
References: click to get abstract/article
1. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA. 2002;288:862-871.
