Morgan Lenney, PharmD
Critical Care Pharmacy Resident
University of Arizona College of Pharmacy
Tucson, Arizona
Disclosure information not submitted.
Brian Kopp, BCCCP, BCPS, PharmD
Clinical Pharmacist
Banner University Medical Center Tucson, United States
Disclosure information not submitted.
Brian Erstad, BCPS, PharmD, MCCM
Professor & Head
University of Arizona College of Pharmacy
Tucson, Arizona
Disclosure information not submitted.
Title: Efficacy of Fixed Dose Hydrocortisone for Septic Shock in Obese and Non-Obese Patients
Introduction: Hydrocortisone is commonly used in the treatment of vasopressor refractory septic shock to reduce the duration of vasopressor use; however, there is minimal data evaluating the efficacy of this fixed dosing regimen in obese patients. Animal and human data in non-critically ill patients suggest that obese patients have increased clearance, volume of distribution, and reductions in intro responsiveness to steroids. This study will evaluate the efficacy of fixed dose hydrocortisone in obese patients compared to non-obese patients with septic shock refractory to adequate fluid resuscitation and vasopressors.
Methods: In this multicenter, retrospective chart review study, we included patients aged 18-89 admitted to the ICU with a confirmed or suspected diagnosis of septic shock using Sepsis 3 criteria who received hydrocortisone (200 mg/day) for vasopressor refractory shock. Subjects were divided into four study groups based on admission BMI (defined as BMI less than 25 kg/m2, BMI 25 to 29.9 kg/m2, BMI 30 to 35 kg/m2, and BMI greater than 35 kg/m2). The primary outcomes analyzed were change in norepinephrine equivalent (NE) dose requirements and mean arterial pressure (MAP) at 6, 12 and 24 hours after initiating hydrocortisone. Secondary outcomes evaluated included time to shock resolution, length of ICU and hospital length of stay (LOS), ICU and hospital mortality, and ventilator-free days at day 28.
Results: There were 219 patients included in the study with approximately equal distribution of patients between groups. Baseline characteristics were similar with a few exceptions such as higher rates of diabetes and coronary artery disease in higher BMI groups. There were no differences in mean NE requirements at 6 hours (p=0.75), 12 hours (p=0.41), and 24 hours (0.61). In addition, there were no significant differences in mean MAP at 6 hours (p=0.56), 12 hours (p=0.15), and 24 hours (p=0.62)). Secondary outcomes including time to shock resolution, ICU and hospital LOS, ICU and hospital mortality, and ventilator-free days at day 28 were similar between BMI groups.
Conclusions: BMI does not appear to impact the efficacy of fixed dose hydrocortisone for septic shock. Fixed dose hydrocortisone should continue to be used for vasopressor refractory septic shock in obese patients.