Should patients in septic shock get corticosteroids?

A meta-analysis of 22 randomized clinical trials (RCTs) published in Intensive Care Medicine in July 2018 compared low-dose steroids vs placebo in adults in septic shock. It found that giving steroids (typically hydrocortisone) did not affect short or long term mortality, but found that the duration of shock, mechanical ventilation, and stay in ICU were reduced. It was found however to increase the risk of adverse effects like hyperglycemia, hypernatremia, and neuromuscular weakness.

Similarly, another meta-analysis published in September 2018 in Critical Care Medicine looked at 42 RCTs. It found that there is small to no reduction in short term mortality and possible small reduction in long term mortality with use of corticosteroids. It too reiterated a small reduction in ICU stay and again an increase in hypernatremia, hyperglycemia, and neuromuscular weakness.

Weigh the risks vs benefit for your next resus/cardiac room patient in septic shock.