What are you looking for ?
Wednesday, May 23, 2018
ADRENAL trial - Adjunctive Glucocorticoid Therapy in Patients with Septic Shock
B. Venkatesh, S. Finfer, et al.
N Engl J Med 2018; 378:797-808
Whether hydrocortisone reduces mortality among patients with septic shock is unclear.
We randomly assigned patients with septic shock who were undergoing mechanical ventilation to receive hydrocortisone (at a dose of 200 mg per day) or placebo for 7 days or until death or discharge from the intensive care unit (ICU), whichever came first. The primary outcome was death from any cause at 90 days.
Hi From March 2013 through April 2017, a total of 3800 patients underwent randomization. Status with respect to the primary outcome was ascertained in 3658 patients (1832 of whom had been assigned to the hydrocortisone group and 1826 to the placebo group). At 90 days, 511 patients (27.9%) in the hydrocortisone group and 526 (28.8%) in the placebo group had died (odds ratio, 0.95; 95% confidence interval [CI], 0.82 to 1.10; P = 0.50). The effect of the trial regimen was similar in six prespecified subgroups.
Patients who had been assigned to receive hydrocortisone had faster resolution of shock than those assigned to the placebo group (median duration, 3 days [interquartile range, 2 to 5] vs. 4 days [interquartile range, 2 to 9]; hazard ratio, 1.32; 95% CI, 1.23 to 1.41; P<0.001).
Patients in the hydrocortisone group had a shorter duration of the initial episode of mechanical ventilation than those in the placebo group (median, 6 days [interquartile range, 3 to 18] vs. 7 days [interquartile range, 3 to 24]; hazard ratio, 1.13; 95% CI, 1.05 to 1.22; P<0.001), but taking into account episodes of recurrence of ventilation, there were no significant differences in the number of days alive and free from mechanical ventilation.
Fewer patients in the hydrocortisone group than in the placebo group received a blood transfusion (37.0% vs. 41.7%; odds ratio, 0.82; 95% CI, 0.72 to 0.94; P = 0.004).
There were no significant between-group differences with respect to mortality at 28 days, the rate of recurrence of shock, the number of days alive and out of the ICU, the number of days alive and out of the hospital, the recurrence of mechanical ventilation, the rate of renalreplacement therapy, and the incidence of new-onset bacteremia or fungemia.
Among patients with septic shock undergoing mechanical ventilation, a continuous infusion of hydrocortisone did not result in lower 90-day mortality than placebo.
(Funded by the National Health and Medical Research Council of Australia and others; ADRENAL ClinicalTrials.gov number, NCT01448109.)
To read the article Click here
Information provided here is for medical education only. It is not intended as and does not substitute for medical advice. If you are a patient, please see your doctor for evaluation of your individual case. The web site should not be used as a substitute for competent medical advice from a licensed physician. By accessing the web site, the visitors acknowledge that there is no physician-patient relationship between them and the author. Under no circumstances will the author be liable to you for any direct or indirect damages arising in connection with use of this website.
The appearance of external hyperlinks to other websites does not constitute endorsement. The author does not verify, endorse, or take responsibility for the accuracy, currency, completeness or quality of the content contained in these sites.
All information provided here is from textbooks/journals. I have provided references and given credit where applicable. I would be glad to take off any images/posts that you think violates your copyright policy. Please shoot an email to firstname.lastname@example.org