In all these trials, cortisol replacement was never associated with even a trend toward serious side effects.
Based on several recently completed randomized controlled trials, cortisol replacement is likely to become a standard of care for vasopressor dependent septic shock.
In the meantime, given the consistency of the results across available trials, cortisol replacement should be considered as a standard of care for patients with vasopressor-dependent septic shock.
However, in the French Ger-Inf-05 trial [25], only nonresponders to the 250-μg ACTH test (cortisol increment < 250 nmol/L) drew benefit from corticosteroids.
However, in the French Ger-Inf-05 trial [ 25], only nonresponders to the 250-μg ACTH test (cortisol increment < 250 nmol/L) drew benefit from corticosteroids.
During the past 5 years, five phase II trials and a phase III placebo-controlled trial on cortisol replacement, i.e. prolonged treatment with physiologic doses of steroids, have been completed in patients with vasopressor-dependent septic shock (Table 1) [ 2, 3, 4, 5, 6].
During both IL-6 trials, plasma cortisol levels returned to preinfusion values after 3 hours of recovery [ 14].
Among the six completed trials of cortisol replacement in septic shock, only two reported separate data according to the results of a short corticotropin test [ 2, 6], and only one trial was adequately powered to assess the survival benefit of cortisol replacement in patients with occult adrenal insufficiency [ 6].
The randomized trial showed heightened cortisol levels in a lab setting among the foster children in the control treatment compared to foster children in the ABC-condition [ 37].
Corticosteroids were associated in Ger-Inf-05 [10], a phase III trial of hydrocortisone plus fludrocortisone, with survival benefit in septic shock and post-corticotrophin increase in cortisol levels ≤9 µg/dl, so-called non-responders [16].
