Articles  |   August 2019
SEE Question
Article Information
Critical Care / Infectious Disease / Articles
Articles   |   August 2019
SEE Question
ASA Monitor 8 2019, Vol.83, 50-51.
ASA Monitor 8 2019, Vol.83, 50-51.
A 59-year-old woman is being emergently transferred to the O.R. for an exploratory laparotomy. She had been admitted to the emergency department with fever and flank pain, and was diagnosed with perforated appendicitis and developing septic shock. While in the O.R., the surgical intensive care unit calls you and requests that you initiate hydrocortisone and fludrocortisone. According to a recent trial, which of the following is most likely to result from this treatment?
The efficacy of steroids for mortality reduction in sepsis has been tested and debated for decades. Prior randomized trials of hydrocortisone in sepsis have failed to demonstrate reduced mortality rates or the prevention of progression to septic shock. Perhaps surprisingly, a trial of hydrocortisone plus fludrocortisone showed a mortality benefit in patients with septic shock and relative adrenal insufficiency. Due to residual opinions of equipoise, a placebo-controlled trial with a 2 × 2 factorial design was launched to assess the efficacy of activated protein C (drotrecogin alfa [Xigris®]) and corticosteroids (hydrocortisone plus fludrocortisone) in septic shock. However, after the market withdrawal of Xigris in 2011, the Xigris arm of the trial was aborted, and the trial was completed in a parallel-group randomized controlled design comparing hydrocortisone plus fludrocortisone to placebo.
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