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until death or discharge from the intensive care unit (ICU), whichever came first. The
primary outcome was death from any cause at 90 days.RESULTSFrom March 2013 through April 2017, a total of 3800 patients underwent randomization.
Status with respect to the primary outcome was ascertained in 3658 patients (1832 of
whom had been assigned to the hydrocortisone group and 1826 to the placebo group). At
90 days, 511 patients (27.9%) in the hydrocortisone group and 526 (28.8%) in the placebo
group had died (odds ratio, 0.95; 95% confidence interval [CI], 0.82 to 1.10; P=0.50). The
effect of the trial regimen was similar in six prespecified subgroups. Patients who had
been assigned to receive hydrocortisone had faster resolution of shock than those
assigned to the placebo group (median duration, 3 days [interquartile range, 2 to 5] vs.
4 days [interquartile range, 2 to 9]; hazard ratio, 1.32; 95% CI, 1.23 to 1.41; P<0.001).
Patients in the hydrocortisone group had a shorter duration of the initial episode of mechanical ventilation than those in the placebo group (median, 6 days [interquartile range,
3 to 18] vs. 7 days [interquartile range, 3 to 24]; hazard ratio, 1.13; 95% CI, 1.05 to 1.22;
P<0.001), but taking into account episodes of recurrence of ventilation, there were no
significant differences in the number of days alive and free from mechanical ventilation.
Fewer patients in the hydrocortisone group than in the placebo group received a blood
transfusion (37.0% vs. 41.7%; odds ratio, 0.82; 95% CI, 0.72 to 0.94; P=0.004). There were
no significant between-group differences with respect to mortality at 28 days, the rate of
recurrence of shock, the number of days alive and out of the ICU, the number of days alive
and out of the hospital, the recurrence of mechanical ventilation, the rate of renal-replacement therapy, and the incidence of new-onset bacteremia or fungemia.CONCLUSIONSAmong patients with septic shock undergoing mechanical ventilation, a continuous infusion of hydrocortisone did not result in lower 90-day mortality than placebo. (Funded by
the National Health and Medical Research Council of Australia and others; ADRENAL
ClinicalTrials.gov number, NCT01448109.)a bs tr ac tAdjunctive Glucocorticoid Therapy in Patients
with Septic Shockwith Septic ShockB. Venkatesh, S. Finfer, J. Cohen, D. Rajbhandari, Y. Arabi, R. Bellomo, L. Billot, M. Correa, P. Glass,
M. Harward, C. Joyce, Q. Li, C. McArthur, A. Perner, A. Rhodes, K. Thompson, S. Webb, and J. Myburgh,
for the ADRENAL Trial Investigators and the Australian–New Zealand Intensive Care Society Clinical Trials Group*
M. Harward, C. Joyce, Q. Li, C. McArthur, A. Perner, A. Rhodes, K. Thompson, S. Webb, and J. Myburgh,
for the ADRENAL Trial Investigators and the Australian–New Zealand Intensive Care Society Clinical Trials Group*The New England Journal of Medicine
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Copyright © 2018 Massachusetts Medical Society. All rights reserved.
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