OBJECTIVE: To observe the effect of low-dose hydrocortisone on the requirement of norepinephrine and lactate clearance in patients with refractory septic shock, and to investigate the effect of stress dose corticosteroids in reversing septic shock and improving tissue oxygen supply. METHODS:Seventy-seven septic shock patients with hypotension refractory to fluids and administration ofnorepinephrine were randomly divided into control and treatment groups. In treatment group intravenous injection of low-dose hydrocortisone was given on top of the treatment given in control group for 14 days. The mean arterial pressure (MAP), lactate clearance and the data of norepinephrine use were compared between two groups during the course of treatment. RESULTS: The number of patients requiring norepinephrine was significantly lower and the MAP was significantly higher in 24 hours, 7 days, 14 days than those at the beginning of treatment in both groups (all P<0.01). Compare to the control group, the course of using norepinephrine was shorter and the number of using norepinephrine was smaller in 7 days in treatment group (both P<0.05 ); the MAP and lactate clearance were higher in 24 hours and 7 days in treatment group (P<0.05 or P<0.01). But there were no differences in mortality and the length of stay in intensive care unit (ICU). CONCLUSION: For the patients with septic shock with refractory hypotension, low-dosehydrocortisone can decrease the time course and dosage of vasopressors, improve tissue oxygen supply, thus can reverse septic shock more rapidly.
RCT Entities:
OBJECTIVE: To observe the effect of low-dose hydrocortisone on the requirement of norepinephrine and lactate clearance in patients with refractory septic shock, and to investigate the effect of stress dose corticosteroids in reversing septic shock and improving tissue oxygen supply. METHODS: Seventy-seven septic shockpatients with hypotension refractory to fluids and administration of norepinephrine were randomly divided into control and treatment groups. In treatment group intravenous injection of low-dose hydrocortisone was given on top of the treatment given in control group for 14 days. The mean arterial pressure (MAP), lactate clearance and the data of norepinephrine use were compared between two groups during the course of treatment. RESULTS: The number of patients requiring norepinephrine was significantly lower and the MAP was significantly higher in 24 hours, 7 days, 14 days than those at the beginning of treatment in both groups (all P<0.01). Compare to the control group, the course of using norepinephrine was shorter and the number of using norepinephrine was smaller in 7 days in treatment group (both P<0.05 ); the MAP and lactate clearance were higher in 24 hours and 7 days in treatment group (P<0.05 or P<0.01). But there were no differences in mortality and the length of stay in intensive care unit (ICU). CONCLUSION: For the patients with septic shock with refractory hypotension, low-dose hydrocortisone can decrease the time course and dosage of vasopressors, improve tissue oxygen supply, thus can reverse septic shock more rapidly.
Authors: Sofie Louise Rygård; Ethan Butler; Anders Granholm; Morten Hylander Møller; Jeremy Cohen; Simon Finfer; Anders Perner; John Myburgh; Balasubramanian Venkatesh; Anthony Delaney Journal: Intensive Care Med Date: 2018-05-14 Impact factor: 17.440
Authors: M Volbeda; J Wetterslev; C Gluud; J G Zijlstra; I C C van der Horst; F Keus Journal: Intensive Care Med Date: 2015-06-23 Impact factor: 17.440
Authors: Ben Gibbison; José A López-López; Julian P T Higgins; Tom Miller; Gianni D Angelini; Stafford L Lightman; Djillali Annane Journal: Crit Care Date: 2017-03-28 Impact factor: 9.097