Hydrocortisone treatment in early sepsis-associated acute respiratory distress syndrome: results of a randomized controlled trial #FOAMed

This trial is worth a read. Courtesy of critical care (Click Icon) Basically

They wanted to see whether sepsis-associated ARDS patients had better outcomes when given Hydrocortisone therapy.

Methods
They randomised patients to receive either hydrocortisone 50 mg every 6 h or placebo.

What they demonstrated

The patients who got hydrocortisone had significant improvement P:F ratios and lung injury scores (statistically significant). They also seemed to have multi-organ support removed more rapidly than the placebo group. 28 day survival was similar though, so there wasn’t a great advantage here. There was more hyperglycaemia in the trial group, and we all know about the adverse effects of this. However, we also know of the hype associated since Van Den Berghe’s first revelation that high BM’s were killing cardiac ICU patients! Hypo’s are obviously to be avoided, but we are slightly more lax these days regarding hyperglycaemic episodes. Hyperglycaemia, unsurprisingly had no impact on outcome.

Conclusions
In sepsis-associated ARDS, hydrocortisone treatment was associated with a significant improvement in pulmonary physiology, but without a significant survival benefit.

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