Comparison of hydrocortisone 100 mg bolus plus 200 mg/day infusion

Background: Current guidelines recommend the addition of hydrocortisone 200 mg/day for the treatment of septic shock unresponsive to fluids and vasopressors. However, the benefits of adding a 100 mg bolus to this regimen remain unclear. The study assessed the efficacy of the administration of hydrocortisone 200 mg/day with or without a 100 mg bolus in refractory septic shock. Methods: This retrospective cohort study included adult patients with refractory septic shock treated at a tertiary care center between 2019 and 2023. Patients were divided into bolus group (receiving a 100 mg hydrocortisone bolus followed by a 200 mg/day continuous infusion) and non-bolus group (receiving a continuous infusion of 200 mg/day without the addition of a bolus) based on physician decision. The primary outcomes were the duration of vasopressor and shock reversal. Secondary outcomes included 28-day mortality and length of hospital stay. Comparisons between groups were performed using chi-squared tests, Results: A total of 184 patients were included, 149 patients in the bolus group and 35 patients in the non-bolus group. The median vasopressor duration was 1 (interquartile range [IQR]: 1-2) days in both groups ( Conclusion: The addition of a 100 mg bolus to a 200 mg/day hydrocortisone regimen may not impact clinical outcomes in refractory septic shock.