Infectious Disease & Sepsis

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February 1, 2024

Effectiveness of Fludrocortisone Plus Hydrocortisone Versus Hydrocortisone Alone in Septic Shock: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials | American Journal of Respiratory and Critical Care Medicine | Articles in Press (atsjournals.org)

In a systematic review and Bayesian network meta-analysis of 17 trials (7,688 patients), fludrocortisone plus hydrocortisone showed a lower risk of all-cause mortality in adult septic shock compared to hydrocortisone alone and placebo/usual care. The combination treatment had a 0.85 relative risk of mortality (moderate-certainty evidence) and was 12% more effective than hydrocortisone alone (low-certainty evidence). The analysis relied mainly on indirect evidence due to limited direct comparisons.

Do you add fludrocortisone to your septic shock patients requiring hydrocortisone?

Sepsis

Dr Mohammed Zakaria

Feb 12

Nowadays There is a very important role for midodrine and fludrocortizone in sepsis to maintain SBP specifically to reverse vasoplegia caused by sepsis

Sometimes we cannot wean pressors

Patients be in very low doses for long time and when pressors omitted blood pressure dropped again

These patient respond very well to midodrine and fludrocortisone

Mazen Kherallah

January 29, 2024

Ceftriaxone to prevent early ventilator-associated pneumonia in patients with acute brain injury: a multicentre, randomised, double-blind, placebo-controlled, assessor-masked superiority trial - The Lancet Respiratory Medicine

The PROPHY-VAP study, a multicenter, randomized trial in eight French hospitals, evaluated the efficacy of a single dose of ceftriaxone in preventing early ventilator-associated pneumonia (VAP) in 319 mechanically ventilated, comatose patients with acute brain injury. Patients were assigned to either ceftriaxone or placebo groups. The study found a significant reduction in early VAP incidence in the ceftriaxone group (14%) compared to the placebo group (32%), with no adverse effects. This led to the recommendation of including ceftriaxone in VAP prevention protocols for such patients.

Pneumonia

Ibrahim Ameen

Jan 30

This used single ceftriaxone dose 2g within 12 hours of intubation. It targets eliminating colonisation in orotracheal tree to decrease VAP incidence in pt with high risk for aspiration(stroke, TBI, ICH, SAH)

. It shows less early VAP,less ventilated days, fewer ICU days, less abx usage, fewer Hopitalisation days, delayed VAP onset in ceftriaxone arm, and only two pt showed ESBL in rectal swab upon discharge in ceftriaxonearm.

The microbiological showed majority of polymicrobial yield

They included GCS 3 - 12 (majority were 4 - 8)

Thanks for sharing, Dr. Mazen

Mazen Kherallah

January 26, 2024

Fludrocortisone Plus Hydrocortisone Versus Hydrocortisone Alone as Adjunctive Therapy in Septic Shock:

A Retrospective Cohort Study" by Lock AE et al., published in the Annals of Pharmacotherapy in 2023, explored whether adding fludrocortisone (FC) to hydrocortisone (HC) would improve the time to septic shock reversal in patients. Conducted as a single-center, retrospective cohort study from March 2017 to May 2020, it included adult ICU patients who received either HC plus FC or HC alone, excluding those with prior corticosteroid use, corticosteroids for other indications, single-dose corticosteroid treatment, or shock due to non-sepsis causes. The primary measure was time to shock reversal, with secondary outcomes including mortality and hyperglycemia rates.

The study found no significant difference in time to shock reversal between the two groups, with 251 patients participating (114 in the HC + FC group and 137 in the HC group). The Cox proportional hazards model did indicate a shorter…

Do you add fludrocortisone in patients with septic shock when hydrocortisone is indicated?