Fact or Fallacy: Corticosteroid Use in Adults with Septic Shock
by Johanna Van Epps, PharmD, Jeffrey Fish, PharmD, FCCM, BCCCP
Question: How does hydrocortisone plus fludrocortisone compare to hydrocortisone alone in adults with septic shock?
Sepsis is defined as life-threatening organ dysfunction caused by dysregulated host response to infection. Septic shock is a subset of sepsis characterized by underlying circulatory, cellular, and metabolic abnormalities and is associated with an increase in mortality. Clinically, patients with septic shock are identified as having persistent hypotension requiring vasopressors to maintain a mean arterial pressure (MAP) of at least 65 mm Hg and having a serum lactate level greater than 2 mmol/L despite adequate fluid resuscitation. Corticosteroids have been an area of interest in patients with sepsis due to their cardiovascular, metabolic, anti-inflammatory, and immunosuppressive physiological effects.
Keywords: Hydrocortisone, Fludrocortisone, Glucocorticoids, Mineralocorticoids, Septic Shock, Intensive Care Unit, Respiratory Distress Syndrome, Adrenal Insufficiency, Arterial Pressure
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2025 March/April Table of Contents
Question: How does hydrocortisone plus fludrocortisone compare to hydrocortisone alone in adults with septic shock?
Sepsis is defined as life-threatening organ dysfunction caused by dysregulated host response to infection. Septic shock is a subset of sepsis characterized by underlying circulatory, cellular, and metabolic abnormalities and is associated with an increase in mortality. Clinically, patients with septic shock are identified as having persistent hypotension requiring vasopressors to maintain a mean arterial pressure (MAP) of at least 65 mm Hg and having a serum lactate level greater than 2 mmol/L despite adequate fluid resuscitation. Corticosteroids have been an area of interest in patients with sepsis due to their cardiovascular, metabolic, anti-inflammatory, and immunosuppressive physiological effects.
Keywords: Hydrocortisone, Fludrocortisone, Glucocorticoids, Mineralocorticoids, Septic Shock, Intensive Care Unit, Respiratory Distress Syndrome, Adrenal Insufficiency, Arterial Pressure
Download PDF
2025 March/April Table of Contents