Hydrocortisone Therapy in Sepsis

Indications and Dosing

The American College of Critical Care Medicine recommends hydrocortisone for patients with septic shock unresponsive to fluid resuscitation and vasopressor therapy, at a dose of 200 mg per day 1
Hydrocortisone is indicated for patients with septic shock who remain hemodynamically unstable despite adequate fluid resuscitation and vasopressor therapy 1, 2
The evidence does not support using hydrocortisone in patients with sepsis without shock, as stated by the Intensive Care Medicine society 2

The recommended dose is intravenous hydrocortisone <400 mg/day for ≥3 days at full dose, according to the Intensive Care Medicine society 2
The standard recommended dose for adults with septic shock is 200 mg per day, as recommended by the Critical Care Medicine society 1
Treatment should be continued until shock resolves, with a minimum duration of 3 days at full dose 2, 3

The Intensive Care Medicine society suggests considering testing for adrenal insufficiency before starting treatment, though treatment should not be delayed while awaiting results 3
Approximately 25% of children with septic shock have absolute adrenal insufficiency, according to the Praxis Medical Insights guideline 4
Delta cortisol (change in baseline cortisol at 60 min of <9 μg/dl) after cosyntropin (250 μg) administration or a random plasma cortisol of <10 μg/dl may help identify patients with adrenal insufficiency, as stated by the Intensive Care Medicine society 2

For children with septic shock, stress-dose corticosteroids may be considered when unresponsive to fluids and requiring vasoactive support, according to the Pediatrics society 5
In newborns, the initial hydrocortisone dose is approximately 5-6 mg/kg/day, which can be titrated up to 50 mg/kg/day if needed to reverse shock, as recommended by the Praxis Medical Insights guideline 4