Potential for overuse of corticosteroids and vasopressin in septic shock

to treat septic shock as per specifi c indications [1]. However, the results from trials evaluating both drugs confl ict. For corticosteroids, the 2002 Annane and colleagues study showed a survival benefi t for hydrocortisone/fl udro cortisone treatment in patients with an inappropriate cortisol response to a high-dose adrenocorticotropic hormone (ACTH) test [2], while the Corticosteroid Th erapy of Septic Shock (CORTICUS) trial found no diff erence in survival by patients’ response to ACTH [3]. Th e Vasopressin and Septic Shock Trial (VASST) demon strated a survival benefi t in less severe septic shock, but guidelines espouse use ‘in patients refractory to other vasopressors’ [1,4]. Clinical variability, leading to over treatment, may have negative eff ects on survival. To evaluate the impact of these evi dence limitations, we surveyed physicians in the Critical Illness Outcomes Study (CIOS). We developed a 15-item, self-administered survey to charac terize physician practice patterns for use of corticosteroids and vasopressin in septic shock. Th e survey, conducted anonymously and with implied consent, was distributed to 92 members of the CIOS listserv. Recipients were encouraged to solicit survey completion by their colleagues. CIOS is a multicenter study among 68 ICUs designed to determine whether ICU-based organi zational and structural factors are associated with patientrelated outcomes. Th e survey fulfi lled Stanford Institutional Review Board exemption guidelines. To address when clinicians would use corticosteroids, we asked partici pants to rate their agreement (fi ve-point Likert scale) for the following situations: blood pressure poorly responsive to fl uid resuscitation and vasopressor therapy; an inappropriate response to ACTH testing [2]; and a history of treatment with corticosteroids within the prior 6 months. Likert responses were evalu ated by Pearson