Hello, this is Jeff Guy. This is the podcast, Surgery, ICU Rounds. I am a professor of surgery at Vanderbilt University Medical Center in Nashville, Tennessee. The topic that I'd like to discuss today is a paper that appeared in New England Journal of Medicine back on January 10th, and we have alluded to it previously in one of our talks podcasts on sepsis, and that's what's known as the corticus trial.

The title of the paper is hydrochortisone therapy for patients with septic shock, and it's by Sprung and colleagues,

and you can find it in the January 10th edition of the New England Journal of Medicine.

I remember a professor of mine in the past saying that in medicine, the questions remain the same, it's only the answers that change.

And I find that true each and every day that a lot of the questions that we think we have answered

in regards to care of patients or the care of critically ill patients continues to change.

I graduated medical school in 1991, which doesn't seem like a long time ago, but now it's been almost 17 years.

And when I was in medical school, we thought we pretty much knew how to fluid resuscitate a patient.

We thought we knew how to manage a patient from a cardiovascular standpoint with things like pulmonary artery catheters.

We thought we knew how to ventilate somebody in ARDS by using high peak

constatory pressures and high levels of peep.

And in that brief period of time, we've seen dramatic changes in the way we manage just

those few things.

And I think the open mind shows every day in critical care that there is changes in the

paradigms in which we manage patients almost on a daily basis. Hydrochortisone or the use of steroids for sepsis is something that's been long debated

and with few answers.

And this paper adds another vital piece of information as to what is the value

for the use of steroids in the septic patient. The authors start out their paper discussing the problem of sepsis,

and I think we've articulated this in the podcast,

Sepsis 1, and Sepsis Part 1 and Sepsis Part 2.

But sepsis, they remind us, is a major cause of morbidity and mortality worldwide

occurring in about 2 to 20% of

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