Physiological dose steroid therapy in sepsis

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

“…Three RCTs used a fixed-duration protocol for treatment [300,302,306], and therapy was decreased after shock resolution in two RCTs [301,310]. In four studies, steroids were tapered over several days [300][301][302]310] and steroids were withdrawn abruptly in two RCTs [306,311]. One crossover study showed hemodynamic and immunologic rebound effects after abrupt cessation of corticosteroids [312].…”

Low-dose steroids for septic shock and severe sepsis: the use of Bayesian statistics to resolve clinical trial controversies

“…Several small trials [5][6][7][8][9], a larger phase II [10], and a most recent phase III trial [11] showed that low-dose steroids could help in shock reversal, but the results on mortality reduction have been contradictory. Three metaanalyses were performed from 2008 to 2009: two [12,13] showed potential mortality benefit, and one showed no mortality benefit [14].…”

The effect of physiologic dose of intravenous hydrocortisone in patients with refractory septic shock: a randomized control trial

“…In a RCT conducted in Turkey intravenous prednisolone was used. In this study, there was no relationship between age, underlying disease, corticosteroid treatment, serum cortisol, response to cosyntropin and finally mortality (11). In another RCT study 50 mg hydrocortisone followed by 0.18 mg/kg/h was given to the intervention group.…”

“…There is only recommendation for hydrocortisone when it is refractory to vasopressors (level 2c) (19). In previous studies, type of steroid (methylprednisolone and hydrocortisone) and method of administration (divided doses versus infusion) did not alter the prognosis and mortality (11)(12)(13). In a study in China, slow intravenous infusion was compared with continuous intravenous infusion of hydrocortisone.…”