Bollaret P-E, Charpentier C, Leoy B, Debouverie M, Audilert G, Larcan A. Reversal of Late Septic Shock With Supraphysiologic Doses of Hydrocortisone.Crit Care Med.1998;26:645-650. In a prospective, randomized, double-blind, placebo-controlled study, 41 patients with septic shock requiring catecholamine for more than 48 hours were treated with either 100 mg of hydrocortisone intravenously 3 times daily for 5 days or matching placebo. Reversal of shock was defined as a stable systolic arterial pressure (>90 mm Hg) for 24 hours or more without catecholamine or fluid infusion. Of the 22 hydrocortisone-treated patients and 19 placebo-treated patients, 68% and 21% achieved 7-day shock reversal, respectively. At 28-day follow-up, reversal remained higher in the hydrocortisone group. Crude 28-day mortality was 32% for the treated patients and 63% for the placebo patients. Shock reversal within 7 days after the onset of corticosteroid therapy was a very strong predictor of survival. Thus, administration of modest doses of hydrocortisone in the setting of pressor-dependent septic shock for a mean of greater than 96 hours resulted in significant improvement in hemodynamics and a beneficial effect on survival. These results contrast with those of older clinical studies in which dexamethasone demonstrated no positive effects. The use of hydrocortisone in this article raises intriguing questions about the efficacy of alternative steroid therapies, which it is hoped will renew interest in them.