title: Low-dose hydrocortisone reduces norepinephrine duration in severe burn patients: a randomized clinical trial.
abstract: BACKGROUND
  The aim of this study was to assess the effect of low-dose corticosteroid therapy in reducing shock duration after severe burn.
  
  
  METHODS
  A placebo-controlled, double-blind, randomized clinical trial (RCT) was performed on two parallel groups in the burn intensive care unit (ICU). Patients were randomized to receive either low-dose corticosteroid therapy or placebo for seven days. A corticotropin test was performed at the time of randomization, before the administration of the treatment dose. Thirty-two severely burned patients with refractory shock (>0.5 μg/kg/min of norepinephrine) were prospectively included in the study.
  
  
  RESULTS
  We included 12 patients in the hydrocortisone-treated group and 15 patients in the placebo group in the final analysis. Among these patients, 21 were nonresponders to the corticotropin test. Median norepinephrine treatment duration (primary objective) was significantly lower in the corticosteroid-treated versus the placebo group (57 hours versus 120 hours, P = 0.035). The number of patients without norepinephrine 72 hours after inclusion was significantly lower in the treated group (P = 0.003, log-rank test analysis). The total quantities of norepinephrine administered to patients were lower in the hydrocortisone-treated versus the placebo group (1,205 μg/kg (1,079 to 2,167) versus 1,971 μg/kg (1,535 to 3,893), P = 0.067). There was no difference in terms of ICU or hospital length of stay, sepsis incidence, cicatrization or mortality.
  
  
  CONCLUSIONS
  In this placebo-controlled, randomized, double-blind clinical trial, we show for the first time that the administration of low-dose hydrocortisone in burn patients with severe shock reduces vasopressor administration.
  
  
  BACKGROUND
  Clinicaltrial.gov NCT00149123 . Registered 6 September 2005.
authors.affiliation: Hospices Civils de Lyon, Cellular Immunology Laboratory, Hôpital E Herriot, Pavillon E - 5 place d'Arsonval, Lyon, Cedex 03 69437, France. fabienne.venet@chu-lyon.fr.|Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon EAM 4174, Lyon, 69008, France. fabienne.venet@chu-lyon.fr.|Hospices Civils de Lyon-bioMérieux Joint Research Unit, Hôpital E Herriot, Pavillon P - 5 place d'Arsonval, Lyon, Cedex 03 69437, France. fabienne.venet@chu-lyon.fr.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Venet
authors.affiliation: Hospices Civils de Lyon-bioMérieux Joint Research Unit, Hôpital E Herriot, Pavillon P - 5 place d'Arsonval, Lyon, Cedex 03 69437, France. jonathan.plassais@gmail.com.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Plassais
authors.affiliation: Hospices Civils de Lyon-bioMérieux Joint Research Unit, Hôpital E Herriot, Pavillon P - 5 place d'Arsonval, Lyon, Cedex 03 69437, France. julien.textoris@biomerieux.com.|Hospices Civils de Lyon, Burn Ward, Intensive Care Unit, Hôpital E Herriot, Pavillon I - 5 place d'Arsonval, Lyon, Cedex 03 69437, France. julien.textoris@biomerieux.com.
authors.forename: Julien
authors.initials: J
authors.lastname: Textoris
authors.affiliation: Hospices Civils de Lyon-bioMérieux Joint Research Unit, Hôpital E Herriot, Pavillon P - 5 place d'Arsonval, Lyon, Cedex 03 69437, France. marie-angelique.cazalis@biomerieux.com.
authors.forename: Marie-Angélique
authors.initials: MA
authors.lastname: Cazalis
authors.affiliation: Hospices Civils de Lyon-bioMérieux Joint Research Unit, Hôpital E Herriot, Pavillon P - 5 place d'Arsonval, Lyon, Cedex 03 69437, France. alexandre.pachot@biomerieux.com.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Pachot
authors.affiliation: Hospices Civils de Lyon, Burn Ward, Intensive Care Unit, Hôpital E Herriot, Pavillon I - 5 place d'Arsonval, Lyon, Cedex 03 69437, France. marc.bertin-maghit@chu-lyon.fr.
authors.forename: Marc
authors.initials: M
authors.lastname: Bertin-Maghit
authors.affiliation: Hospices Civils de Lyon, Burn Ward, Intensive Care Unit, Hôpital E Herriot, Pavillon I - 5 place d'Arsonval, Lyon, Cedex 03 69437, France. christophe.magnin@chu-lyon.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Magnin
authors.affiliation: Hospices Civils de Lyon, Burn Ward, Intensive Care Unit, Hôpital E Herriot, Pavillon I - 5 place d'Arsonval, Lyon, Cedex 03 69437, France. thomas.rimmele@chu-lyon.fr.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rimmelé
authors.affiliation: Hospices Civils de Lyon, Cellular Immunology Laboratory, Hôpital E Herriot, Pavillon E - 5 place d'Arsonval, Lyon, Cedex 03 69437, France. guillaume.monneret@chu-lyon.fr.|Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon EAM 4174, Lyon, 69008, France. guillaume.monneret@chu-lyon.fr.|Hospices Civils de Lyon-bioMérieux Joint Research Unit, Hôpital E Herriot, Pavillon P - 5 place d'Arsonval, Lyon, Cedex 03 69437, France. guillaume.monneret@chu-lyon.fr.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Monneret
authors.affiliation: Hospices Civils de Lyon, Burn Ward, Intensive Care Unit, Hôpital E Herriot, Pavillon I - 5 place d'Arsonval, Lyon, Cedex 03 69437, France. sylvie.tissot@chu-lyon.fr.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Tissot
mesh_terms: D002056:Burns / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D004311:Double-Blind Method; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000627:therapeutic use*; D009638:Norepinephrine / Q000037:antagonists & inhibitors* / Q000378:metabolism; D012769:Shock / Q000188:drug therapy*; D012772:Shock, Septic / Q000401:mortality* / Q000473:pathology
chemical_list: D006854:Hydrocortisone; D009638:Norepinephrine