Clinical Q, Primary Outcome, Bottom Lines #1

Question 1

Annane Clinical Question

Answer 1

Among patients with septic shock and relative adrenal insufficiency, do corticosteroids reduce 28-day mortality

Question 2

Annane Bottom Line

Answer 2

Among patients with septic shock and relative adrenal insufficiency, administration of corticosteroids reduces 28-day mortality, although this finding was not confirmed in the follow-up CORTICUS, HYPRESS, or ADRENAL trials, but confirmed in APROCCHSS.

Question 3

ADRENAL Clinical Question

Answer 3

In patients with septic shock requiring ventilatory and vasopressor support, does a continuous week-long infusion of hydrocortisone 200 mg/day improve mortality at 90 days when compared to placebo?

Question 4

ADRENAL Primary outcome

Answer 4

90-day mortality

Question 5

ADRENAL Bottom Line

Answer 5

In patients with septic shock on mechanical ventilation and receiving vasopressors, a week of hydrocortisone 200 mg/day did not reduce 90 day mortality but may be associated with time until reversal of shock, time to extubation, length of ICU stay, and blood transfusion.