Hydrocortisone in Septic Shock

Introduction to Hydrocortisone Use

The Society of Critical Care Medicine recommends hydrocortisone use only in patients with septic shock who remain hypotensive despite adequate fluid resuscitation and moderate-to-high dose vasopressor therapy, administered as 200 mg/day intravenously for at least 3 days at full dose 1, 2, 3

The American College of Critical Care Medicine suggests reserving hydrocortisone for vasopressor-unresponsive septic shock only, and not using it if hemodynamic stability can be achieved with fluids and vasopressors alone 4, 5
The European Society of Intensive Care Medicine recommends initiating hydrocortisone when patients require moderate-to-high dose vasopressors (>0.1 μg/kg/min norepinephrine equivalent) after adequate fluid resuscitation 1, 3

The Society of Critical Care Medicine recommends using low-dose, long-duration therapy with hydrocortisone <400 mg/day (typically 200 mg/day) 1, 2, 3
The European Society of Intensive Care Medicine suggests continuing hydrocortisone for at least 3 days at full dose 1, 3
The American College of Critical Care Medicine recommends administering hydrocortisone as a continuous infusion (preferred) or divided doses every 6 hours 4, 2, 3

The Society of Critical Care Medicine recommends not using the ACTH stimulation test to guide hydrocortisone therapy, as it does not predict shock reversal or mortality benefit 4, 1, 2, 3

The European Society of Intensive Care Medicine suggests monitoring for hyperglycemia, the most common adverse effect of hydrocortisone 1, 3
The American College of Critical Care Medicine recommends monitoring for hypernatremia and increased risk of superinfection, including new sepsis and septic shock 1, 3, 2

The Society of Critical Care Medicine recommends avoiding the use of hydrocortisone in sepsis without shock, as it provides no benefit and may cause harm 1
The European Society of Intensive Care Medicine suggests avoiding high-dose, short-course steroids, as they are ineffective or harmful 1, 3