Adjunctive early hydrocortisone therapy does not prevent the development of septic shock in patients with severe sepsis

The Hydrocortisone  for Prevention of Septic Shock (HYPRESS) study was published in JAMA on Oct 3, 2016.

380 patients with sepsis (with evidence of infection plus at least 2 systemic inflammatory response syndrome criteria and evidence of organ dysfunction ) were  randomized either to receive a continuous infusion of 200 mg of hydrocortisone for 5 days or placebo.

There was no difference in the proportion of septic shock development after 14 days(Primary endpoint). There was no difference in time to development to septic shock.

There was no difference in 28-day, 90-day, 180-day, ICU, or hospital all-cause mortality; LOS in the ICU or hospital; ventilation- or renal replacement–free days; or median SOFA score(Secondary outcome).


Surviving sepsis guidelines about steroids in sepsis

1. Not using intravenous hydrocortisone to treat adult septic shock patients if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability . In case this is not achievable, we suggest intravenous hydrocortisone alone at a dose of 200 mg per day (grade 2C).

2. Not using the ACTH stimulation test to identify adults with septic shock who should receive hydrocortisone (grade 2B).

3. In treated patients hydrocortisone tapered when vasopressors are no longer required (grade 2D).

4. Corticosteroids not be administered for the treatment of sepsis in the absence of shock (grade 1D).

5. When hydrocortisone is given, use continuous flow (grade 2D).



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