In a systematic review and Bayesian network meta-analysis of 17 trials (7,688 patients), fludrocortisone plus hydrocortisone showed a lower risk of all-cause mortality in adult septic shock compared to hydrocortisone alone and placebo/usual care. The combination treatment had a 0.85 relative risk of mortality (moderate-certainty evidence) and was 12% more effective than hydrocortisone alone (low-certainty evidence). The analysis relied mainly on indirect evidence due to limited direct comparisons.
Do you add fludrocortisone to your septic shock patients requiring hydrocortisone?
Yes
No
Nowadays There is a very important role for midodrine and fludrocortizone in sepsis to maintain SBP specifically to reverse vasoplegia caused by sepsis
Sometimes we cannot wean pressors
Patients be in very low doses for long time and when pressors omitted blood pressure dropped again
These patient respond very well to midodrine and fludrocortisone