Related Experiment Video
Updated: Aug 8, 2025
08:37
Echocardiographic Assessment Using Subxiphoid-Only Examination for Hypotensive Patients
Published on: April 18, 2025
380
Adjunctive Hydrocortisone Improves Hemodynamics in Critically Ill Patients with Septic Shock: An Observational Study
Leonie Jochheim1, David Jochheim2, Livia Habenicht3
1Klinik für Gastroenterologie und Hepatologie, Uniklinikum Essen, Essen, Germany.
Journal of Intensive Care Medicine
|March 6, 2023
Summary
Hydrocortisone therapy rapidly decreased catecholamine needs and improved circulation in septic shock patients. Hemodynamic changes predicted 28-day mortality, showing its prognostic value.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Hemodynamics
Background:
- Septic shock presents high mortality and hemodynamic instability.
- Limited data exists on steroid mechanisms and prognostic value in improving hemodynamics.
Purpose of the Study:
- To evaluate short-term effects of hydrocortisone on catecholamine requirements and hemodynamics in septic shock.
- To assess the prognostic ability of hemodynamic changes for 28-day mortality.
Main Methods:
- 30 critically ill septic shock patients received hydrocortisone (200mg bolus, 200mg/24h infusion).
- Transpulmonary thermodilution (TPTD) assessed hemodynamics (VDI, CPI) at baseline and 2, 8, 16, 24 hours.
- Primary endpoints: vasopressor dependency index (VDI) and cardiac power index (CPI).
Main Results:
- Hydrocortisone significantly decreased VDI and increased CPI within 24 hours.
- Noradrenaline requirement reduced, with improvements in mean arterial pressure, systemic vascular resistance index, and cardiac index.
- Significant reduction in lung water parameters observed; ΔCPI and ΔVDI predicted 28-day mortality (AUC 0.802 vs 0.769).
Conclusions:
- Adjunctive hydrocortisone rapidly reduces catecholamine needs in septic shock.
- It leads to substantial circulatory improvement and has prognostic value for mortality prediction.
Related Concept Videos
01:22Heart Failure VI: Adjunct Therapies
20
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
20
01:30Heart Failure V: Medical Management
18
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
18
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
479
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
479
01:22Heart Failure Drugs: Diuretics
435
Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
435
01:29Heart Failure II: Pathophysiology
19
Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
19
01:30Adrenergic Agonists: Therapeutic Uses
876
Adrenergic agonists have diverse therapeutic uses across various medical conditions and emergencies.
Emergency and Intensive Care Unit (ICU) applications: Pressor agents increase blood pressure, heart rate, and contractility in shock and organ failure situations. Dopamine can induce vasodilation and stimulate adrenoceptors. Endogenous catecholamines are effective in treating cardiogenic shock. α2-agonists like clonidine can reverse anesthesia-induced hypertension.
Allergies and...
Emergency and Intensive Care Unit (ICU) applications: Pressor agents increase blood pressure, heart rate, and contractility in shock and organ failure situations. Dopamine can induce vasodilation and stimulate adrenoceptors. Endogenous catecholamines are effective in treating cardiogenic shock. α2-agonists like clonidine can reverse anesthesia-induced hypertension.
Allergies and...
876