Septic shock (associated with relative adrenal insufficiency) is characterized by decreased arterial responsiveness to catecholamines. The association of hydrocortisone and fludrocortisone has demonstrated an improvement in survival in septic shock patients. If hydrocortisone has shown to increase vascular responsiveness, the role of fludrocortisone remains to be elucidated. The purpose of our study is to investigate the effect of a physiological dose of fludrocortisone alone on norepinephrine-mean arterial pressure dose-response relationship, gastric mucosal perfusion and arterial stiffness in patients with septic shock.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
50 µg of fludrocortisone per os
1 tablet of placebo per os
Service de Réanimation Chirurgicale - Hôpital de Pontchaillou
Rennes, France
Norepinephrine-mean arterial pressure dose-response relationship
Time frame: 1.5 h after administration
Systolic and diastolic arterial pressures, heart rate, cardiac output, systemic vascular resistances
Time frame: During 3 h after administration
Central aortic pressures, Augmentation Index (Aix).
Time frame: During 3 h after administration
Arterial stiffness: Carotid-femoral Pulse Wave Velocity
Time frame: During 3 h after administration
Humeral diameter and distensibility
Time frame: During 3 h after administration
Gastric mucosal perfusion
Time frame: During 3 h after administration
Plasma electrolytes, blood glucose, serum creatinine
Time frame: Each hour during 3 h after administration
Plasma renin, aldosterone, norepinephrine, epinephrine, fludrocortisone, TNF alpha concentrations
Time frame: Each hour during 3 h after administration
Urinary electrolytes excretion
Time frame: Each hour during 3 h after administration
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