R.E:B.E.L.EM - May 11, 2020 - By Salim Rezaie
"Clinical Question:
We tend to think of sepsis as this kind of bag where we throw in fluids, vasopressors and antibiotics early so we can improve outcomes. Should steroids be included? What is the evidence that shows that steroids work in septic shock?...
Conclusion:
“I say: certainly, if the patient has risk of adrenal insufficiency due to chronic steroid therapy, it’s a no brainer, make it happen. If the patient is requiring multiple doses of pressors, you’re starting to max out your norepinephrine and you’re starting to think maybe I should add a second or third pressor. In order to get them off of those pressors faster and out of shock, I would give them a stress dose of steroids. And I am using hydrocortisone and not fludrocortisone”