Steroids in acute respiratory distress syndrome: A panacea or still a puzzle?

Table 5 Comparison of major studies of steroids in septic shock

Ref.	Acronym/Abbreviation	Country, number of participating sites	Number of patients	Type of patient population	Intervention group	Control group	Primary outcome	Remarks
Annane et al[33], 2002	---	France, 19	300	Adults with septic shock	IV hydrocortisone 50 mg bolus every 6th hourly and oral Fludrocortisone 50 mcg every 24 h for 7 d	Placebo	Mortality at 28 d	Trial has subdivided patients into ACTH stimulation responders and non-responders
Sprung et al[34], 2008	CORTICUS	Multi-national, 52	499	Adults with septic shock	IV hydrocortisone 50 mg every 6th hourly for 5 d, then 50 mg every 12th hourly for 3 d, then 50 mg once daily for 3 d	Placebo	Mortality at 28 d	Study found a non-statistically significant increased risk of superinfection with steroid group
Keh et al[35], 2016	HYPRESS	Germany, 34	380	Adults with severe sepsis	IV hydrocortisone bolus 50 mg followed by a continuous infusion of 200 mg daily for 3 d	Placebo		Underpowered study
Annane et al[36], 2018	APROCCHSS	France, 34	1241	Adults with septic shock	IV hydrocortisone 50 mg bolus every 6th hourly and oral fludrocortisone 50 mcg every 24 h for 7 d	Placebo	Mortality at 90 d	Showed benefit in 90-d mortality contrasting to no benefit in ADRENAL trial
Venkatesh et al[32], 2018	ADRENAL	Multi-national, 69	3800	Adults with septic shock	IV hydrocortisone 200 mg every day for a maximum of 7 d or until ICU discharge or death	Placebo	Mortality at 90 d	Largest trial till date on steroids in septic shock

ICU: Intensive care unit.