ADRENAL

Adjunctive Corticosteroid Treatment in Critically Ill Patients with Septic Shock

Patient / Population Intervention / Exposure Comparison Outcome

In 3,800 mechanically ventilated patients with septic shock, hydrocortisone 200 mg/day did not reduce 90-day mortality versus placebo, but accelerated shock reversal and discharge.

3,800

Design

Double-blind RCT, ANZICS

Endpoint

90-day all-cause mortality

Relevance

Result27.9% vs 28.8% (OR 0.95; 95% CI 0.82–1.10; p=0.50). Faster shock reversal (HR 1.32); shorter ICU and ventilation.

Venkatesh B, et al. N Engl J Med. 2018;378(9):797-808. 10.1056/NEJMoa1705835

Discussion & critique

Defines the modern indication: hydrocortisone for haemodynamic and ventilator weaning, not for mortality alone.