EBQ:CORTICUS Trial: Difference between revisions

Revision as of 01:19, 2 December 2013

Complete Journal Club Article

Sprung CL, et al. "Hydrocortisone therapy for patients with septic shock". New England Journal of Medicine. 2008. 358(2):111-24.
PubMed Full text PDF

Clinical Question

Does low-dose hydrocortisone therapy improve survival in patients with septic shock?

Conclusion

Hydrocortisone increase the speed to shock reversal.

Major Points

2012 Guidelines

Design

Inclusion Criteria

Exclusion Criteria

Interventions

Outcome

Primary Outcomes

Secondary Outcomes

Subgroup analysis

Criticisms

Funding

Supported by the European Commission, the European Society of Intensive Care Medicine, the European Critical Care Research Network, the International Sepsis Forum, and the Gorham Foundation. Roche Diagnostics provided the Elecsys cortisol immunoassay.

CME

Sources

Authors:

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	hydrocortisone improved survival in patients with septic shock who did not have a response to corticotropin
	hydrocortisone hastened reversal of shock in patients with septic shock who did not have a response to corticotropin
	hydrocortisone increased the incidence of superinfection
	hydrocortisone hastened the reversal of shock in patients in whom shock was reversed
	hydrocortisone improved survival in patients with septic shock only if they had a response to corticotropin

	a single dose of etomidate inhibited the metabolism of corticosteroids for 24 hours in patients who were critically ill
	an association between etomidate and the likelihood of adrenal hyporesponsiveness was found
	both of the above
	neither of the above

	mortality was significantly reduced in patients who received steroids
	mortality was only reduced in patients who had a positive corticotropin test
	mortality was only reduced in patients who had a negative corticotropin test
	shock was reversed more quickly in the steroid group, when compared to the placebo group
	there were fewer episodes of superinfection in the steroid group