Web site designed and maintained by Chris Cairns  © SICS EBM Group 2004                                  

Up

 

Hydrocortisone may make shock reversal more likely.

 

 

No clear outcome difference between hydrocortisone and placebo.    Earlier reversal of shock in hydrocortisone group.
Level 1- evidence (limited by small sample size)

 

Citation/s:Stress doses of hydrocortisone reverse hyperdynamic septic shock. Critical Care Medicine 1999; 27: 723 - 732.
 

Lead author's name and fax: J Briegel, Ludwig-Maximillians-Universitat Munich,

 

Three-part Clinical Question: In patients with septic shock, does the use of low dose steroid compared to standard therapy, lead to a reduction in 28-day mortality?
 

Search Terms: 1. exp sepsis/ or severe sep$.tw or sept$.tw or sepsi$.tw (50301), 2. exp critical care/ or critical ca$.tw or intensive ca$.tw (22553), 3. exp hydrocortisone/ or hydrocort$.tw or exp steroids/ or steroi$.tw (110778), 4. 1 and 2 and 3 (107), 5. therapy filter (652119), 6. 4 and 5 (70)

 

The Study: Double-blinded concealed randomised controlled trial with intention-to-treat.
 

The Study Patients: 40 consecutive patients meeting ACCP / SCCM criteria for septic shock. Carried out in one German ICU over 3-year period. Patients age > 18 and < 75. Additional criterion: was vasopressor support and high output circulatory failure with CI > 4l.min-1.m-2.  Primary end-point cessation of inotropic support (adrenaline or noradrenaline) or only low dose dopamine
 

Control group (N = 20; 20 analysed): Identical placebo (saline) in same manner as active drug. All patient had A- CVP- and PA-lines. Measurements recorded at 12 h intervals for 48 h, then 24 h thereafter.
 

Experimental group (N = 20; 20 analysed): Hydrocortisone 100mg over 30 min, then 0.18 mg.kg-1.h-1. At reversal of septic shock reduced to 0.08 mg.kg-1.h-1.

 

The Evidence:

Outcome

Time to Outcome

CER

EER

RRR

ARR

NNT

Mortality

 

0.300

0.20

33%

0.100

10

95% Confidence Intervals:

-56% to 100%

-0.167 to 0.367

NNT = 3 to INF; NNH = 6 to INF

Failure of reversal of shock

30 days

0.200

0.100

50%

0.100

10

95% Confidence Intervals:

-60% to 100%

-0.119 to 0.319

NNT = 3 to INF; NNH = 8 to INF

 

Comments:


1. Reversal of shock sooner in hydrocortisone group.
2. No difference in ICU outcome: but limited by small sample size.

 

Appraised by: Malcolm Daniel, Department of Anaesthesia, Glasgow Royal Infirmary ; Sunday, August 25, 2002      Email: md23s@udcf.gla.ac.uk

 

Printer-friendly format