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Flashcards in Sepsis: Annane Deck (7)
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1
Q

Annane Clinical Question

A

Among patients with septic shock and relative adrenal insufficiency, do corticosteroids reduce 28-day mortality

2
Q

Annane Bottom Line

A

Among patients with septic shock and relative adrenal insufficiency, administration of corticosteroids reduces 28-day mortality, although this finding was not confirmed in the follow-up CORTICUS, HYPRESS, or ADRENAL trials, but confirmed in APROCCHSS.

3
Q

Annane Design and n

A

Randomized, prospective, double-blind, parallel-group, placebo-controlled trial,N=300

4
Q

Annane inclusion criteria

A
  • Age ≥18 years
  • Hospitalized in ICU
  • Documented site or strong suspicion of infection
  • Temperature ≥38.3°C or ≤35.6°C
  • Heart rate ≥90 BPM
  • SBP <90 mmHg for ≥1 hour despite IVF, dopamine >5mcg/kg/min, any epinephrine, or any norepinephrine
  • Urine output ≤0.5 mL/kg for ≥1 hour or the PaO2/FiO2 -≤280 mmHg
  • Lactate levels ≥2 mmol/L
  • Mechanical ventilation
5
Q

Annane exclusion criteria

A
Pregnancy
MI
PE
Advanced cancer
AIDS
Contraindication for corticosteroids
Etomidate in the previous 6 hours (late amendment to protocol)
6
Q

Annane criticisms

A
  • Some of the “nonresponders” had a pre-ACTH cortisol level of <34mcg/dL [<938 nmol/L] and therefore may have been classified as having absolute adrenal insufficiency.
  • The study’s generalizability is limited because patients receiving etomidate were excluded, patients were generally more ill, and all patients received mechanical ventilation.
7
Q

Annane Interventions

A
  • Hydrocortisone 50mg IV q6h and fludrocortisone 50mcg daily for 7 days
  • Placebo

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