The role of corticosteroids in septic shock has been debated for decades. Some studies suggested benefit, others demonstrated little effect, and clinicians remained divided regarding when steroids should be used.
One of the central physiologic questions was whether severe septic shock represents a state of relative adrenal insufficiency. If patients cannot mount an adequate endogenous stress response, corticosteroid supplementation may help restore vascular responsiveness and improve hemodynamics.
The APROCCHSS trial sought to evaluate whether a combination of hydrocortisone and fludrocortisone could improve outcomes in severe septic shock.
Published in 2018, APROCCHSS randomized patients with severe septic shock to receive hydrocortisone plus fludrocortisone or placebo. Patients were critically ill, requiring substantial vasopressor support and demonstrating high severity of illness.