A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock.

@article{Bone1987ACC,
  title={A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock.},
  author={Roger C. Bone and Charles Jack Fisher and Terry P. Clemmer and Gus J. Slotman and Craig A. Metz and Robert A. Balk},
  journal={The New England journal of medicine},
  year={1987},
  volume={317 11},
  pages={
          653-8
        }
}
The use of high-dose corticosteroids in the treatment of severe sepsis and septic shock remains controversial. Our study was designed as a prospective, randomized, double-blind, placebo-controlled trial of high-dose methylprednisolone sodium succinate for severe sepsis and septic shock. Diagnosis was based on the clinical suspicion of infection plus the presence of fever or hypothermia (rectal temperature greater than 38.3 degrees C [101 degrees F] or less than 35.6 degrees C [96 degrees F… 
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Administration of modest doses of hydrocortisone in the setting of pressor-dependent septic shock for a mean of >96 hrs resulted in a significant improvement in hemodynamics and a beneficial effect on survival.
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In this trial, a 7-day treatment with low doses of hydrocortisone and fludrocort isone significantly reduced the risk of death in patients with septic shock and relative adrenal insufficiency without increasing adverse events.
Stress doses of hydrocortisone reverse hyperdynamic septic shock: a prospective, randomized, double-blind, single-center study.
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Infusion of stress doses of hydrocortisone reduced the time to cessation of vasopressor therapy in human septic shock and was associated with a trend to earlier resolution of sepsis-induced organ dysfunctions.
CAGS and ACS evidence based reviews in surgery. 35: Efficacy and safety of low-dose hydrocortisone therapy in the treatment of septic shock.
TLDR
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 hydroc Cortisone therapy.
Steroids for septic shock: back from the dead? (Con).
TLDR
Concerns regarding a trend for higher mortality among corticotropin responders and the possibility that patients with true adrenal insufficiency may have been enrolled in this placebo-controlled trial, potentially skewing results, should be considered.
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