Evaluation of the role of hydrocortisone either alone or combined with fludrocortisone in the outcome of septic shock in adults

Abstract

Background Management of sepsis is a time critical procedure; the consequences of improperly managed sepsis and septic shock can cause multiple organ dysfunction and death. The aim of this study was to evaluate of the role of hydrocortisone either alone or with fludrocortisone on the outcome septic shock in adults. This study was conducted on 66 patients who were assigned randomly to 3 groups each containing 22 patients. Control group had received standard therapy for sepsis, and H group had received standard therapy for sepsis plus hydrocortisone. HF group had received standard therapy for sepsis plus hydrocortisone and fludrocortisone. Results It showed that the use of corticosteroids (the hydrocortisone or the hydrocortisone plus fludrocortisone) in septic patients was associated with significant reduction in the time to wean from vasopressors and length of intensive care unit stay. Meanwhile, there were no significant effect of the mortality rate, Sepsis-Related Organ Failure Assessment (SOFA) score reduction, gastrointestinal bleeding, and superinfection as corticosteroids adverse effects between the three groups. Conclusions The corticosteroids in septic shock have significant positive impacts on some aspects in treatment of septic shock but it does not affect the mortality rate of the patients.

Do We Need to Administer Fludrocortisone in Addition to Hydrocortisone in Adult Patients With Septic Shock? An Updated Systematic Review With Bayesian Network Meta-Analysis of Randomized Controlled Trials and an Observational Study With Target Trial Emulation*

“…Additionally, we included one RCT ( 39 ) and a TTE-based cohort study ( 40 ) to assess the efficacy of hydrocortisone plus fludrocortisone versus hydrocortisone alone. We also identified a three-armed RCT ( 41 ). The detailed summaries and maps of these studies are presented in Supplementary Tables 1 and 2 ( http://links.lww.com/CCM/H472 ), respectively.…”

“…Generally, large sample sizes enhance study power by providing clear effect size estimates and minimizing chance results, a principle that is equally applicable to (network) meta-analysis ( 45 ). A notable feature of our NMA is the inclusion of a three-armed RCT ( 41 ) and a recent cohort study (88,275 patients) with TTE ( 40 ). The use of TTE in observational studies stimulates researchers to formulate research questions for hypothetical RCTs that compare drug effectiveness ( 46 ).…”