SCCM Resource Library-Two Years After the ADRENAL Trial: Time to Close the Debate on Steroids in Sepsis?

Video Transcription

Video Summary

In this video, Dr. Bala Subramanian Venkatesh discusses the use of steroids in septic shock. He begins by stating that steroids and sepsis is an ongoing and interesting topic of debate. He mentions that the use of steroids in sepsis has evolved over time, with different dosing strategies and agents being used. He highlights the variability in how practitioners handle steroids in septic shock, with different opinions on when to start and taper it. Dr. Venkatesh then introduces the principal investigator of the funded adrenal trial, Dr. Bala Subramanian Venkatesh, who presents the findings of the trial. The adrenal trial enrolled over 3,800 patients with septic shock and compared hydrocortisone to placebo. The primary outcome of 90-day mortality was not significantly different between the two groups. However, secondary outcomes such as faster resolution of shock and shorter duration of mechanical ventilation were observed in the hydrocortisone group. Dr. Venkatesh discusses the differences in findings between the adrenal trial and other trials, such as the APROX trial. He also addresses questions about the appropriate timing, dosing, and use of adjunctive medications like fludrocortisone. He concludes by summarizing the current recommendations, including the use of hydrocortisone at 200mg/day for 7 days in mechanically ventilated patients with septic shock.

Asset Subtitle

Sepsis, Pharmacology, 2020

Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2020 Critical Care Congress held February 16-19, 2020, in Orlando, Florida, USA.

Learning Objectives

Explain the need for steroids in sepsis, septic shock, and resuscitation
Question the outcomes of landmark steroids in sepsis trials
Develop a plan to manage shock states in the ICU with the need for steroid replacement

Two Years After the ADRENAL Trial: Time to Close the Debate on Steroids in Sepsis?

Balasubramanian Venkatesh

Meta Tag

Content Type Presentation

Knowledge Area Sepsis

Knowledge Area Pharmacology

Knowledge Level Advanced

Learning Pathway Sepsis Resources

Membership Level Select

Membership Level Professional

Membership Level Associate

Tag Shock

Tag Inflammation

Year 2020

Keywords

steroids

septic shock

sepsis

dosing strategies

adrenal trial

hydrocortisone

mortality

mechanical ventilation

recommendations

Pharmacology

Shock

Inflammation

Presentation

Select

Professional

Associate

2020

Advanced

Sepsis Resources

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