Systemic shock wiki2/21/2024 ![]() ![]() Keeping this in mind, that may explain why trials with the addition of fludricortisone demonstrate their benefit. Keeping in mind that the definition is based on measuring sodium-retention, hydrocortisone is cleaved at mineralocorticoid sites. Mineralocorticoid equivalents may be an over simplification of steroid action in the body. They did not detect any difference in adverse events such as blood transfusion (negative control outcome), hypernatremia, or health care associated infection between groups. They also found the addition of fludricortisone led to more ventilator-free and hospital-free days. They tested multiple sensitivity analyses where this finding remained robust. For their primary outcome of in-hospital mortality or ICU discharge to hospice, the combination therapy demonstrated 47.2% mortality whereas the hydrocortisone alone had 50.8% (adjusted risk difference -3.7%, P < 0.001). ![]() The authors analyzed registry data from 88 275 patients hospitalized with septic shock, received norepinephrine hemodynamic support, and were treated with hydrocortisone-fludrocortisone (n=2280) compared to hydrocortisone alone (n=85 995) within 3 days of hospitalization. ![]() This retrospective registry trial sought to clarify the addition of fludricortisone to hydrocortisone in septic shock. Trials such as the Annane Trial or APROCCHSS showed benefit with the addition of fludricortisone whereas the CORTICUS, HYPRESS, and ADRENAL trials did not add fludricortisone. Some of the prevailing logic is that hydrocortisone at 200mg/day should have adequate mineralocorticoid activity and the addition of fludricortisone would not add much benefit. The surviving sepsis guidelines recommends adding IV hydrocortisone. ![]() There currently are no large, randomized trials comparing hydrocortisone alone to the addition of fludricortisone in septic shock. The addition of fludricortisone to hydrocortisone lowered the adjusted absolute risk of mortality. In adult patients with septic shock receiving norepinephrine, what does adding fludricortisone to hydrocortisone as compared to hydrocortisone alone for in hospital death or discharge to hospice. ![]()
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