Shock Management: Corticosteroids in Hypotension

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Questions and Answers

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?

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?

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?

Low level of evidence Signup and view all the answers

What is the primary mechanism of action of fludrocortisone in septic shock?

Mineralocorticoid activity Signup and view all the answers

What is the recommended approach to using norepinephrine in septic shock?

Increase the dose to maintain hemorrhagic pressure Signup and view all the answers

What is the primary benefit of using corticosteroids in septic shock patients?

Improved hemodynamic stability Signup and view all the answers

What is the goal of titrating the norepinephrine dose in septic shock patients?

To maintain adequate blood pressure Signup and view all the answers

What is the recommended initial dose of vasopressin?

0.03 units/minute Signup and view all the answers

What is the primary benefit of using corticosteroids in septic shock?

Improving cardiovascular output Signup and view all the answers

What is the contraindication for using vasopressin in septic shock?

Severe hypertension Signup and view all the answers

What is the recommended threshold for random cortisol levels to initiate IV hydrocortisone therapy?

<10 μg/dL Signup and view all the answers

What is the purpose of the short corticotropin (ACTH) stimulation test?

To diagnose adrenal insufficiency Signup and view all the answers

What is the primary mechanism of noradrenaline in septic shock?

Vasoconstriction and increasing blood pressure Signup and view all the answers

When is corticosteroid therapy contraindicated in septic shock?

When there is no definitive hypotension Signup and view all the answers

What is the recommended dose of IV hydrocortisone in septic shock?

200 mg daily in two divided doses Signup and view all the answers

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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Description

This quiz assesses your understanding of corticosteroids in managing hypotension, including the use of fludrocortisone and hydrocortisone. Learn about the indication and benefits of corticosteroids in reducing mortality and recovery time.