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Sepsis & Septic Shock

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Fludrocortisone Plus Hydrocortisone Versus Hydrocortisone Alone as Adjunctive Therapy in Septic Shock:

A Retrospective Cohort Study" by Lock AE et al., published in the Annals of Pharmacotherapy in 2023, explored whether adding fludrocortisone (FC) to hydrocortisone (HC) would improve the time to septic shock reversal in patients. Conducted as a single-center, retrospective cohort study from March 2017 to May 2020, it included adult ICU patients who received either HC plus FC or HC alone, excluding those with prior corticosteroid use, corticosteroids for other indications, single-dose corticosteroid treatment, or shock due to non-sepsis causes. The primary measure was time to shock reversal, with secondary outcomes including mortality and hyperglycemia rates.

The study found no significant difference in time to shock reversal between the two groups, with 251 patients participating (114 in the HC + FC group and 137 in the HC group). The Cox proportional hazards model did indicate a shorter time to shock resolution with HC + FC, but there was no significant difference in in-hospital mortality or hyperglycemia rates, although the HC + FC group showed higher hyperglycemia rates. The study acknowledged potential biases and confounders due to its retrospective nature and changes in practice following the APROCCHSS trial publication in 2018. The authors concluded that FC addition to HC does not reduce the time to septic shock reversal, suggesting the need for a randomized controlled trial (RCT) to further investigate these findings.


Do you add fludrocortisone in patients with septic shock when hydrocortisone is indicated?

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https://pubmed.ncbi.nlm.nih.gov/37026172/

Ibrahim Ameen
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