Introduction Sepsis causes organ dysfunction due to the body’s response to infection, with early management essential. Septic shock involves persistent low blood pressure despite treatment, affecting all organ systems. Corticosteroids and glucocorticoids reduce inflammation and vasodilation, while fludrocortisone enhances vascular responsiveness to norepinephrine, improving treatment outcomes. Objective This study compared fludrocortisone with hydrocortisone versus hydrocortisone alone in early septic shock, assessing outcomes in terms of morbidity (recovery and hospital stay reduction) and mortality. Patients and methods In this study, 90 septic shock patients, following the 2021 Surviving Sepsis Campaign guidelines, were assessed using APACHE II and SOFA scores upon ICU admission. Lab, culture, and radiological investigations were conducted, and initial fluid resuscitation with IV broad-spectrum antimicrobials was provided. Patients were divided into two groups: group I received hydrocortisone only, and group II received both hydrocortisone and fludrocortisone. Hydrocortisone was given as a 50 mg IV bolus every 6 h for 7 days, and fludrocortisone as a 0.1 mg tablet in 20 ml water via nasogastric route for 7 days. Vital signs and lab data were collected daily, with SOFA score, CRP, and serum lactate measured every 48 h. Outcomes were evaluated over 7 days and 28-day survival, including ICU stay length, vasopressor and mechanical ventilation-free days, and complication development. Results Combining fludrocortisone with hydrocortisone improved CRP levels on days 5 and 7, but showed no additional benefits over hydrocortisone alone in terms of Glascow Coma Scale and SOFA scores, vitals, lab results, norepinephrine doses, urine output, mechanical ventilation needs, ICU stay, and mortality. Conclusions The study emphasizes the importance of early and comprehensive management in septic shock. It finds no additional benefits of combining fludrocortisone with hydrocortisone over hydrocortisone alone but underscores the need for standardized protocols and comprehensive treatment regimens to improve patient outcomes following surviving sepsis campaign 2021 guidelines.
Hamouda et al. (Sat,) studied this question.