Effect of Treatment With Low Doses of Hydrocortisone and Fludrocortisone on Mortality in Patients With Septic Shock

EVERE SEPSIS REMAINS AN IMPORtant cause of death, accounting for 9.3% of all deaths in the United States in 1995. 1 If our understanding of the mechanisms of host response to stress has strongly progressed during the last 2 decades, 2 the various drugs developed for specific targets of the cytokine cascade have failed to improve patient survival. 3,4orticosteroids were the first antiinflammatory drugs tested in randomized trials.At high doses during short courses, they did not induce favorable effects. 5,6However, the observation that severe sepsis may be associated with relative adrenal insufficiency 7,8 or systemic inflammation-induced glucocorticoid receptor resistance 9 prompted renewed interest of a replacement therapy