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The HYPRESS randomised clinical trial evaluated continuous hydrocortisone in adults with severe sepsis who were not yet in septic shock. The clinical question was whether early corticosteroids could prevent progression to shock. Hydrocortisone did not significantly reduce the development of septic shock. Mortality outcomes were also not improved, while hyperglycaemia and muscle weakness were more frequent in the hydrocortisone group. The study is clinically useful because it demonstrates why a treatment supported in one phase of critical illness should not automatically be moved to an earlier phase without evidence. Steroids may have a role in refractory septic shock, but this trial did not support giving them routinely to patients with severe sepsis before shock develops. This fits CritiCARE's themes of evolving sepsis management and evidence-based corticosteroid use. For HCPs, the takeaway is simple: treatment timing matters. Before starting steroids, identify the clinical indication and the patient state rather than treating the presence of infection or organ dysfunction alone as sufficient justification. The trial also reinforces the need to balance potential haemodynamic benefit against metabolic and neuromuscular adverse effects.
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The HYPRESS randomised clinical trial evaluated continuous hydrocortisone in adults with severe sepsis who were not yet in septic shock. The clinical question was whether early corticosteroids could prevent progression to shock. Hydrocortisone did not significantly reduce the development of septic shock. Mortality outcomes were also not improved, while hyperglycaemia and muscle weakness were more frequent in the hydrocortisone group. The study is clinically useful because it demonstrates why a treatment supported in one phase of critical illness should not automatically be moved to an earlier phase without evidence. Steroids may have a role in refractory septic shock, but this trial did not support giving them routinely to patients with severe sepsis before shock develops. This fits CritiCARE's themes of evolving sepsis management and evidence-based corticosteroid use. For HCPs, the takeaway is simple: treatment timing matters. Before starting steroids, identify the clinical indication and the patient state rather than treating the presence of infection or organ dysfunction alone as sufficient justification. The trial also reinforces the need to balance potential haemodynamic benefit against metabolic and neuromuscular adverse effects.
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