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Prescribing Patterns of Hydrocortisone in Septic Shock: a Single-Center Experience of How Surviving Sepsis Guidelines are Interpreted and Translated into Bedside Practice
Study Question: What are the triggers for hydrocortisone (HC) prescribing in the absence of clear criteria for use in patients with septic shock?
Study Description: The study was conducted in two phases: a retrospective chart review of corticosteroid prescribing patterns in septic shock patients requiring vasopressor therapy and a survey to evaluate self-described prescribing habits of intensivists.
Results: A total of 155 patients met inclusion criteria, 99 (64%) of whom received an order for IV HC after the administration of ≥ 2 concomitant vasopressors. The majority of patients (n = 113, 73%) had at least one vasopressor infusing at a high dose, as defined by study investigators, upon HC initiation. The majority of prescribed HC doses were between 200 and 300 mg per day in divided doses (83%) and within 24 hours of severe sepsis protocol commencement (83%). Thirty-two percent of patients died prior to steroid weaning or discontinuation, while 39% were weaned and 30% were discontinued without tapering, irrespective of vasopressor status. Of the 36 ICU intensivists surveyed, 75% responded. Based on survey results, practitioner attitude and prescribing pattern were closely correlated.
Conclusion(s): Variability in corticosteroid prescribing practices is likely due to vague Surviving Sepsis Campaign criteria for use definitions.
Perspective: Guideline interpretation for application to bedside practice can produce variable results when published definitions are unclear. Typically, practitioners are encouraged to look more closely at the primary literature from which these recommendations were based for guidance. Unfortunately, in the case of corticosteroids in severe sepsis, methodology and results are disparate among published trials.