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Sepsis & Septic Shock

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Effectiveness of Fludrocortisone Plus Hydrocortisone Versus Hydrocortisone Alone in Septic Shock: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials | American Journal of Respiratory and Critical Care Medicine | Articles in Press (

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

Ibrahim Ameen
Ibrahim Ameen
Souhila  Mansour
ياسر الوالي

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

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