Abstract | OBJECTIVES: DESIGN: Prospective, randomized, double-blind, placebo-controlled study. SETTING: Two intensive care units of a University hospital. PATIENTS: INTERVENTIONS: Patients were randomly assigned either hydrocortisone (100 mg i.v. three times daily for 5 days) or matching placebo. MEASUREMENTS AND MAIN RESULTS: Reversal of shock was defined by a stable systolic arterial pressure (>90 mm Hg) for > or =24 hrs without catecholamine or fluid infusion. Of the 22 hydrocortisone-treated patients and 19 placebo-treated patients, 15 (68%) and 4 (21%) achieved 7-day shock reversal, respectively, a difference of 47% (95% confidence interval 17% to 77%; p = .007). Serial invasive hemodynamic measurements for 5 days did not show significant differences between both groups. At 28-day follow-up, reversal of shock was higher in the hydrocortisone group (p = .005). Crude 28-day mortality was 7 (32%) of 22 treated patients and 12 (63%) of 19 placebo patients, a difference of 31% (95% confidence interval 1% to 61%; p = .091). Shock reversal within 7 days after the onset of corticosteroid therapy was a very strong predictor of survival. There were no significant differences in outcome in responders and nonresponders to a short corticotropin test. The respective rates of gastrointestinal bleeding and secondary infections did not differ between both groups. CONCLUSIONS: 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. These beneficial effects do not appear related to adrenocortical insufficiency.
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Authors | P E Bollaert, C Charpentier, B Levy, M Debouverie, G Audibert, A Larcan |
Journal | Critical care medicine
(Crit Care Med)
Vol. 26
Issue 4
Pg. 645-50
(Apr 1998)
ISSN: 0090-3493 [Print] United States |
PMID | 9559600
(Publication Type: Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Anti-Inflammatory Agents
- Catecholamines
- Hydrocortisone
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Topics |
- APACHE
- Adult
- Aged
- Aged, 80 and over
- Anti-Inflammatory Agents
(administration & dosage, blood)
- Catecholamines
(blood)
- Double-Blind Method
- Female
- Hemodynamics
(drug effects)
- Humans
- Hydrocortisone
(administration & dosage, blood)
- Male
- Middle Aged
- Shock, Septic
(drug therapy, mortality)
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