New insights into the management of severe sepsis and septic shock

Surviving Sepsis guidelines regardingcorticosteroid therapy in severe sepsisUnchanged from 2008, and continue to recommend: Hydrocortisone 300 mg / day or less in patients withseptic shock “only after it has been confirmed thattheir blood pressure is poorly responsive to fluidresuscitation and vasopressor therapy.” (Grade 2C:weak recommendation, low quality evidence) No benefit of continuous vs. bolus infusions has beendemonstrated Adding fludrocortisone to hydrocortisone is associatedwith a higher infection rate, and shouldn’t benecessary as hydrocortisone has mineralocorticoidactivity. Surviving Sepsis calls fludrocortisone anoptional adjunctive treatment to hydrocortisone.