ADRENAL trial versus APROCCHSS trial: to steroid or not to steroid?

Septic shock remains a major challenge in critically ill patients with a mortality rate of 30% to 50% (1-3). The 2016 Surviving Sepsis Campaign (SSC) guidelines recommend the use of hydrocortisone to treat patients with septic shock if adequate fluid resuscitation and vasopressor therapy cannot restore hemodynamic stability (4). Although glucocorticoids have been used as an adjuvant therapy for septic shock for more than 50 years, the quality of evidence for this weak recommendation remains low (4). Two recent systemic reviews and meta-analyses have reported different conclusions on the ability of glucocorticoids to reducing 28-day mortality (5,6).