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The CORTICUS randomised trial examined low-dose hydrocortisone in adults with septic shock. The study was designed to test whether corticosteroids could improve survival, particularly in patients who did not respond normally to corticotropin stimulation. Hydrocortisone accelerated improvement in measures of organ dysfunction and cardiovascular instability, but the trial did not show a significant mortality benefit. The findings were important because they separated faster haemodynamic recovery from improved survival. That distinction remains clinically useful. Steroids may shorten the duration of shock in selected patients, but their use involves trade-offs such as hyperglycaemia, neuromuscular weakness and infection risk. Modern sepsis practice therefore focuses on who remains vasopressor-dependent and how severe the shock is rather than treating every septic patient with corticosteroids. CORTICUS complements more contemporary steroid trials and is directly relevant to CritiCARE sessions on steroid use, vasopressor dependence and sepsis beyond the guidelines. For HCPs, the practical message is to define the clinical objective before starting corticosteroids: faster shock resolution is a different endpoint from mortality reduction. Treatment decisions should be based on the patient's haemodynamic state, timing and contraindications, with careful monitoring for adverse effects.
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The CORTICUS randomised trial examined low-dose hydrocortisone in adults with septic shock. The study was designed to test whether corticosteroids could improve survival, particularly in patients who did not respond normally to corticotropin stimulation. Hydrocortisone accelerated improvement in measures of organ dysfunction and cardiovascular instability, but the trial did not show a significant mortality benefit. The findings were important because they separated faster haemodynamic recovery from improved survival. That distinction remains clinically useful. Steroids may shorten the duration of shock in selected patients, but their use involves trade-offs such as hyperglycaemia, neuromuscular weakness and infection risk. Modern sepsis practice therefore focuses on who remains vasopressor-dependent and how severe the shock is rather than treating every septic patient with corticosteroids. CORTICUS complements more contemporary steroid trials and is directly relevant to CritiCARE sessions on steroid use, vasopressor dependence and sepsis beyond the guidelines. For HCPs, the practical message is to define the clinical objective before starting corticosteroids: faster shock resolution is a different endpoint from mortality reduction. Treatment decisions should be based on the patient's haemodynamic state, timing and contraindications, with careful monitoring for adverse effects.
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