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While use of etomidate has been associated with adverse outcomes in some studies, treatment with low-dose hydrocortisone does not consistently improve outcomes in such patients.(20-25) The combination of vasopressin and hydrocortisone is effective for reducing catecholamine requirements and may have synergistic effects in septic shock.(26,27)Studies that have examined low-dose corticosteroids in patients with septic shock found conflicting results. Subsequent meta-analyses found that longer courses (at least five days) of low-dose corticosteroids (hydrocortisone 200-300 mg/day) decreased mortality without a significant increase in complication rates.(28,29) The 2004 Surviving Sepsis Campaign guidelines recommended low-dose hydrocortisone in vasopressor-dependent septic shock after fluid resuscitation.(30)In 2008, the multicenter Corticosteroid Therapy of Septic Shock (CORTICUS) study randomized 499 patients with septic shock to low-dose IV hydrocortisone (50 mg every six hours) or placebo.(15) This study found no reduction in 28-day mortality with hydrocortisone in patients with or without an impaired cortisol response to ACTH (hydrocortisone vs. More episodes of superinfection were seen in the hydrocortisone group, including new sepsis and septic shock.