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Questions and Answers
What is the primary goal of using vasopressors and hydrocortisone in the management of septic shock?
What is the primary goal of using vasopressors and hydrocortisone in the management of septic shock?
- To restore adequate blood pressure (correct)
- To reduce the recovery time of corticosteroids
- To reduce mortality rates
- To promote intravascular volume resuscitation
What is the recommended approach to using corticosteroids in septic shock according to the SCCM/ESICM/SCACM/ACCP/ATS/SIS International Guidelines?
What is the recommended approach to using corticosteroids in septic shock according to the SCCM/ESICM/SCACM/ACCP/ATS/SIS International Guidelines?
- Use corticosteroids only in patients with severe septic shock
- Use corticosteroids in combination with vasopressors
- Use corticosteroids only after adequate fluid resuscitation and vasopressors have failed to restore blood pressure (correct)
- Use corticosteroids as a first-line treatment
What was the primary finding of the STOP study and the CORTICUS study?
What was the primary finding of the STOP study and the CORTICUS study?
- High-dose steroids have similar mortality rates to placebo in septic shock patients
- Basal dose of steroids is more effective than placebo in septic shock patients
- High-dose steroids are more effective than placebo in septic shock patients (correct)
- Basal dose of steroids has similar mortality rates to placebo in septic shock patients
What is the level of evidence supporting the use of corticosteroids in septic shock?
What is the level of evidence supporting the use of corticosteroids in septic shock?
What is the primary mechanism of action of fludrocortisone in septic shock?
What is the primary mechanism of action of fludrocortisone in septic shock?
What is the recommended approach to using norepinephrine in septic shock?
What is the recommended approach to using norepinephrine in septic shock?
What is the primary benefit of using corticosteroids in septic shock patients?
What is the primary benefit of using corticosteroids in septic shock patients?
What is the goal of titrating the norepinephrine dose in septic shock patients?
What is the goal of titrating the norepinephrine dose in septic shock patients?
What is the recommended initial dose of vasopressin?
What is the recommended initial dose of vasopressin?
What is the primary benefit of using corticosteroids in septic shock?
What is the primary benefit of using corticosteroids in septic shock?
What is the contraindication for using vasopressin in septic shock?
What is the contraindication for using vasopressin in septic shock?
What is the recommended threshold for random cortisol levels to initiate IV hydrocortisone therapy?
What is the recommended threshold for random cortisol levels to initiate IV hydrocortisone therapy?
What is the purpose of the short corticotropin (ACTH) stimulation test?
What is the purpose of the short corticotropin (ACTH) stimulation test?
What is the primary mechanism of noradrenaline in septic shock?
What is the primary mechanism of noradrenaline in septic shock?
When is corticosteroid therapy contraindicated in septic shock?
When is corticosteroid therapy contraindicated in septic shock?
What is the recommended dose of IV hydrocortisone in septic shock?
What is the recommended dose of IV hydrocortisone in septic shock?
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Study Notes
Management of Septic Shock
- When hypotension persists after using vasopressors and hydrocortisone, additional hormones like fludrocortisone may be indicated.
- Fludrocortisone is preferred to reestablish hemodynamic stability, reduce mortality, and shorten the recovery time of corticosteroids.
Corticosteroids in Septic Shock
- The SCCM/ESICM/SCACM/ACCP/ATS/SIS International Guidelines recommend the use of corticosteroids in septic shock only if adequate fluid resuscitation and vasopressors fail to restore adequate blood pressure.
- The STOP and CORTICUS studies evaluated high-dose steroids versus placebo and basal dose of steroids in septic shock patients.
- The Clark and Annane mortality rate observed a 15% mortality rate in the sodium cortisone group compared to 38.9% in the placebo group.
Vasopressors
- Norepinephrine is the medication of choice, with a target mean arterial pressure (MAP) of 65 mmHg.
- Noradrenaline has the best cardiovascular response in normal blood pressure and reduces metabolic demand.
- Vasopressin can be used concomitantly with norepinephrine in noradrenaline-resistant shock, with an initial dose of 0.03 units/minute, which may increase to 0.04 units/minute.
Adjunctive Therapies
- Corticosteroids can enhance or complement the effects of traditional interventions, with most studies showing reversion of shock, increased cardiovascular output, and lesser organ dysfunction.
- However, some populations do not have a proven benefit with this intervention.
Guidelines for Corticosteroid Use
- The 2016 Surviving Sepsis Campaign guidelines recommend the use of IV hydrocortisone 200 mg daily in two divided doses in septic shock within 15 minutes of diagnosis.
- A random cortisol level of ≤10 μg/dL is an indication for hydrocortisone use.
- If the random cortisol level is between 10 and 34 μg/dL, a short corticotropin (ACTH) stimulation test should be performed.
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