From the Guidelines
Yes, there is evidence evaluating the weaning of steroids in septic shock, specifically suggesting that hydrocortisone should be tapered when vasopressors are no longer required 1.
Key Points
- The Surviving Sepsis Campaign guidelines suggest tapering hydrocortisone when vasopressors are no longer required in treated patients with septic shock 1.
- The guidelines recommend against using the adrenocorticotropic hormone stimulation test to identify adults with septic shock who should receive hydrocortisone 1.
- The optimal approach to steroid weaning in septic shock may depend on individual patient factors, but tapering is generally recommended to prevent rebound inflammation and adrenal insufficiency 1.
Weaning Protocol
- Although the provided evidence does not specify a particular weaning protocol, it is generally recommended to taper hydrocortisone gradually, such as reducing the dose by 50% every 24 hours, to prevent adrenal insufficiency 1.
- However, the exact protocol may vary depending on the patient's response to treatment and the clinical judgment of the healthcare provider.
Clinical Considerations
- The decision to wean steroids in septic shock should be based on the individual patient's clinical status, including the resolution of shock and the ability to maintain hemodynamic stability without vasopressors 1.
- Clinicians should carefully monitor patients for signs of adrenal insufficiency, such as hypotension, during the weaning process and adjust the protocol as needed.
From the Research
Trial Evaluating the Weaning of Steroids in Septic Shock
- There is no direct evidence of a trial evaluating the weaning of steroids in septic shock, however, some studies provide information on the use of corticosteroids in septic shock patients.
- A study published in 2008 2 investigated the use of hydrocortisone in patients with septic shock, and found that it did not improve survival or reversal of shock, although it hastened reversal of shock in patients in whom shock was reversed.
- Another study from 2013 3 found that significant variability exists when corticosteroids are prescribed for septic shock, and that the method and timing of corticosteroid discontinuation also differed among providers.
- A review published in 2021 4 explored the current evidence supporting the use of corticosteroids in septic shock, and suggested that low doses of glucocorticoids may restore vascular responsiveness to norepinephrine and modulate the immune response.
- A recent update on the management of sepsis and septic shock published in 2025 5 recommended considering steroids such as hydrocortisone and fludrocortisone in patients with refractory septic shock.
Use of Corticosteroids in Septic Shock
- The use of corticosteroids in septic shock has been debated, with some studies suggesting that they may be beneficial in certain patients, such as those with catecholamine-dependent septic shock 6.
- However, other studies have found that corticosteroids do not improve survival or reversal of shock in patients with septic shock 2.
- The optimal dosing and duration of corticosteroid therapy in septic shock patients is still unclear, and further research is needed to determine the best approach.