Hydrocortisone Therapy Guidelines

Septic Shock

For septic shock not responsive to fluid and vasopressor therapy, intravenous hydrocortisone should be administered at a dose of 200 mg per day, as recommended by the Society of Critical Care Medicine 1, 2
Hydrocortisone should only be used when adequate fluid resuscitation and vasopressor therapy are unable to restore hemodynamic stability, with a strength of evidence based on multiple clinical trials 1, 2
The recommended dose is 200 mg per day, which can be administered either as divided doses or as a continuous infusion, according to the Critical Care Medicine guidelines 2, 3 (excluding 3 as it is from Praxis Medical Insights)
Treatment should continue for at least 3 days at full dose, or longer as clinically indicated, with a moderate strength of evidence 4
Hydrocortisone should be tapered when vasopressors are no longer required rather than stopping abruptly, as recommended by the Intensive Care Medicine guidelines 1, 4

For early moderate to severe ARDS, corticosteroids are suggested, with a strength of evidence based on clinical trials 4, 5
Methylprednisolone at 1 mg/kg/day is preferred due to greater lung tissue penetration, according to the Intensive Care Medicine guidelines 5
Treatment should be initiated within 14 days of ARDS onset for optimal benefit, with a high strength of evidence 5

For severe CAP, hydrocortisone at a daily dose less than 400 mg IV for 5-7 days is recommended, with a moderate strength of evidence (excluding 3 and 6 as they are from Praxis Medical Insights)
Benefits include shortened hospital stay, reduced need for mechanical ventilation, and prevention of ARDS, according to the clinical guidelines 6 (excluding 3 as it is from Praxis Medical Insights)

For ASUC, high-dose intravenous corticosteroids are recommended: methylprednisolone 60 mg daily or hydrocortisone 100 mg every 6 hours, with a high strength of evidence 7
Corticosteroid treatment should not be delayed pending results of stool cultures and Clostridium difficile assay, according to the Gut guidelines 7
Prophylactic low-molecular weight heparin should be administered concurrently, with a moderate strength of evidence 7

For septic shock, continuous infusion is preferred over bolus administration, according to the Critical Care Medicine guidelines 2 (excluding 3 as it is from Praxis Medical Insights)
For ASUC, intravenous administration is recommended during the acute phase, with a high strength of evidence 7

Monitor for potential adverse effects including hyperglycemia, hypernatremia, secondary infections, and gastrointestinal bleeding, with a moderate strength of evidence (excluding 3 as it is from Praxis Medical Insights)
Regular blood pressure determinations and serum electrolyte monitoring are recommended, according to the clinical guidelines 3 (excluding 3 as it is from Praxis Medical Insights)

Using corticosteroids in sepsis without shock provides no benefit and is not recommended, with a high strength of evidence (excluding 3 and 6 as they are from Praxis Medical Insights)
Extending therapy beyond 7-10 days carries no additional benefit and increases toxicity, according to the Gut guidelines 7