***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: CONTEXT AND OBJECTIVE Sepsis and septic shock are very common conditions among critically ill patients that lead to multiple organ dysfunction syndrome ( MODS ) and death . Our purpose was to investigate the efficacy of early administration of dexamethasone for patients with septic shock , with the aim of halting the progression towards MODS and death . DESIGN AND SETTING Prospect i ve , r and omized , double-blind , single-center study , developed in a surgical intensive care unit at Hospital das Clínicas , Faculdade de Medicina da Universidade de São Paulo . METHODS The study involved 29 patients with septic shock . All eligible patients were prospect ively r and omized to receive either a dose of 0.2 mg/kg of dexamethasone ( group D ) or placebo ( group P ) , given three times at intervals of 36 hours . The patients were monitored over a seven-day period by means of the sequential organ failure assessment score . RESULTS Patients treated with dexamethasone did not require vasopressor therapy for as much time over the seven-day period as did the placebo group ( p = 0.043 ) . Seven-day mortality was 67 % in group P ( 10 out of 15 ) and 21 % in group D ( 3 out of 14 ) ( relative risk = 0.31 , 95 % confidence interval 0.11 to 0.88 ) . Dexamethasone enhanced the effects of vasopressor drugs . CONCLUSIONS Early treatment with dexamethasone reduced the seven-day mortality among septic shock patients and showed a trend towards reduction of 28-day mortality BACKGROUND Septic shock is characterized by dysregulation of the host response to infection , with circulatory , cellular , and metabolic abnormalities . We hypothesized that therapy with hydrocortisone plus fludrocortisone or with drotrecogin alfa ( activated ) , which can modulate the host response , would improve the clinical outcomes of patients with septic shock . METHODS In this multicenter , double‐blind , r and omized trial with a 2‐by‐2 factorial design , we evaluated the effect of hydrocortisone‐plus‐fludrocortisone therapy , drotrecogin alfa ( activated ) , the combination of the three drugs , or their respective placebos . The primary outcome was 90‐day all‐cause mortality . Secondary outcomes included mortality at intensive care unit ( ICU ) discharge and hospital discharge and at day 28 and day 180 and the number of days alive and free of vasopressors , mechanical ventilation , or organ failure . After drotrecogin alfa ( activated ) was withdrawn from the market , the trial continued with a two‐group parallel design . The analysis compared patients who received hydrocortisone plus fludrocortisone with those who did not ( placebo group ) . RESULTS Among the 1241 patients included in the trial , the 90‐day mortality was 43.0 % ( 264 of 614 patients ) in the hydrocortisone‐plus‐fludrocortisone group and 49.1 % ( 308 of 627 patients ) in the placebo group ( P=0.03 ) . The relative risk of death in the hydrocortisone‐plus‐fludrocortisone group was 0.88 ( 95 % confidence interval , 0.78 to 0.99 ) . Mortality was significantly lower in the hydrocortisone‐plus‐fludrocortisone group than in the placebo group at ICU discharge ( 35.4 % vs. 41.0 % , P=0.04 ) , hospital discharge ( 39.0 % vs. 45.3 % , P=0.02 ) , and day 180 ( 46.6 % vs. 52.5 % , P=0.04 ) but not at day 28 ( 33.7 % and 38.9 % , respectively ; P=0.06 ) . The number of vasopressor‐free days to day 28 was significantly higher in the hydrocortisone‐plus‐fludrocortisone group than in the placebo group ( 17 vs. 15 days , P<0.001 ) , as was the number of organ‐failure – free days ( 14 vs. 12 days , P=0.003 ) . The number of ventilator‐free days was similar in the two groups ( 11 days in the hydrocortisone‐plus‐fludrocortisone group and 10 in the placebo group , P=0.07 ) . The rate of serious adverse events did not differ significantly between the two groups , but hyperglycemia was more common in hydrocortisone‐plus‐fludrocortisone group . CONCLUSIONS In this trial involving patients with septic shock  , 90‐day all‐cause mortality was lower among those who received hydrocortisone plus fludrocortisone than among those who received placebo . ( Funded by Programme Hospitalier de Recherche Clinique 2007 of the French Ministry of Social Affairs and Health ; APROCCHSS Clinical Trials.gov number , NCT00625209 . Background Authors of recent meta-analyses have reported that prolonged glucocorticoid treatment is associated with significant improvements in patients with severe pneumonia or acute respiratory distress syndrome ( ARDS ) of multifactorial etiology . A prospect i ve r and omized trial limited to patients with sepsis-associated ARDS is lacking . The objective of our study was to evaluate the efficacy of hydrocortisone treatment in sepsis-associated ARDS . Methods In this double-blind , single-center ( Siriraj Hospital , Bangkok ) , r and omized , placebo-controlled trial , we recruited adult patients with severe sepsis within 12 h of their meeting ARDS criteria . Patients were r and omly assigned ( 1:1 ratio ) to receive either hydrocortisone 50 mg every 6 h or placebo . The primary endpoint was 28-day all-cause mortality ; secondary endpoints included survival without organ support on day 28 . Results Over the course of 4 years , 197 patients were r and omized to either  hydrocortisone  ( n = 98 ) or placebo ( n = 99 ) and were included in this intention-to-treat analysis . The treatment group had significant improvement in the ratio of partial pressure of oxygen in arterial blood to fraction of inspired oxygen and lung injury score ( p = 0.01 ) , and similar timing to removal of vital organ support ( HR 0.74 , 95 % CI 0.51–1.07 ; p = 0.107 ) . After adjustment for significant covariates , day 28 survival was similar for the whole group ( HR 0.80 , 95 % CI 0.46–1.41 ; p = 0.44 ) and for the larger subgroup ( n = 126 ) with Acute Physiology and Chronic Health Evaluation II score < 25 ( HR 0.57 , 95 % CI 0.24–1.36 ; p = 0.20 ) . With the exception of hyperglycemia ( 80.6 % vs. 67.7 % ; p = 0.04 ) , the rate of adverse events was similar . Hyperglycemia had no impact on outcome . Conclusions In sepsis-associated ARDS , hydrocortisone treatment was associated with a significant improvement in pulmonary physiology , but without a significant survival benefit . Trial registration Clinical Trials.gov identifier NCT01284452 . Registered on 18 January 2011 Objective : To determine the feasibility of conducting a r and omized controlled trial of corticosteroids in pediatric septic shock . Design : R and omized , double-blind , placebo controlled trial . Setting : Seven tertiary level PICUs in Canada . Patients : Children newborn to 17 years old inclusive with suspected septic shock . Intervention : Administration of IV hydrocortisone versus placebo until hemodynamic stability is achieved or for a maximum of 7 days . Measurements and Main Results : One hundred seventy-four patients were potentially eligible of whom 101 patients met eligibility criteria . Fifty-seven patients were r and omized , and 49 patients ( 23 and 26 patients in the hydrocortisone and placebo groups , respectively ) were included in the final analysis . The mean time from screening to r and omization was 2.4 ± 2.1 hours and from screening to first dose of study drug was 3.8 ± 2.6 hours . Forty-two percent of potentially eligible patients ( 73/174 ) received corticosteroids prior to r and omization : 38.5 % ( 67/174 ) were already on corticosteroids for shock at the time of screening , and in 3.4 % ( 6/174 ) , the treating physician wished to administer corticosteroids . Six of 49 r and omized patients ( 12.2 % ) received open-label steroids , three in each of the hydrocortisone and placebo  groups . Time on vasopressors , days on mechanical ventilation , PICU and hospital length of stay , and the rate of adverse events were not statistically different between the two groups . Conclusions : This study suggests that a large r and omized controlled trial on early use of corticosteroids in pediatric septic shock is potentially feasible . However , the frequent use of empiric corticosteroids in otherwise eligible patients remains a significant challenge . Knowledge translation activities , targeted recruitment , and alternative study design s are possible strategies to mitigate this challenge Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more We hypothesize that hydrocortisone infusion in severe community-acquired pneumonia attenuates systemic inflammation and leads to earlier resolution of pneumonia and a reduction in sepsis-related complications . In a multicenter trial , patients admitted to the Intensive Care Unit ( ICU ) with severe community-acquired pneumonia received protocol -guided antibiotic treatment and were r and omly assigned to hydrocortisone infusion or placebo . Hydrocortisone was given as an intravenous 200-mg bolus followed by infusion at a rate of 10 mg/hour for 7 days . Primary end-points of the study were improvement in Pa(O(2)):FI(O(2 ) ) ( Pa(O(2)):FI(O(2 ) ) > 300 or > /= 100 increase from study entry ) and multiple organ dysfunction syndrome ( MODS ) score by Study Day 8 and reduction in delayed septic shock .  Forty-six patients entered the study . At study entry , the  hydrocortisone group had lower Pa(O(2)):FI(O(2 ) ) , and higher chest radiograph score and C-reactive protein level . By Study Day 8 , treated patients had , compared with control subjects , a significant improvement in Pa(O(2)):FI(O(2 ) ) ( p = 0.002 ) and chest radiograph score ( p < 0.0001 ) , and a significant reduction in C-reactive protein levels ( p = 0.01 ) , MODS score ( p = 0.003 ) , and delayed septic shock ( p = 0.001 ) . Hydrocortisone treatment was associated with a significant reduction in length of hospital stay ( p = 0.03 ) and mortality ( p = 0.009 ) RATIONALE Some studies have shown a beneficial effect of corticosteroids in patients with community-acquired pneumonia ( CAP ) , possibly by diminishing local and systemic antiinflammatory host response . OBJECTIVES To assess the efficacy of adjunctive prednisolone treatment in patients hospitalized with CAP . METHODS Hospitalized patients , clinical ly and radiologically diagnosed with CAP using st and ard clinical and radiological criteria , were r and omized to receive 40 mg prednisolone for 7 days or placebo , along with antibiotics . Primary outcome was clinical cure at Day 7 . Secondary outcomes were clinical cure at Day 30 , length of stay , time to clinical stability , defervescence , and C-reactive protein . Disease severity was scored using CURB-65 ( a severity index for community-acquired pneumonia evaluating Confusion , blood Urea nitrogen , Respiratory rate , Blood pressure , and age 65 or older ) and Pneumonia Severity Index . MEASUREMENTS AND MAIN RESULTS We enrolled 213 patients . Fifty-four ( 25.4 % ) patients had a CURB-65 score greater than 2 , and 93 ( 43.7 % ) patients were in Pneumonia Severity Index class IV-V. Clinical cure at Days 7 and 30 was 84/104 ( 80.8 % ) and 69/104 ( 66.3 % ) in the prednisolone group and 93/109 ( 85.3 % ) and 84/109 ( 77.1 % ) in the placebo group ( P = 0.38 and P = 0.08 ) . Patients on prednisolone had faster defervescence and faster decline in serum C-reactive protein levels compared with placebo . Sub analysis of patients with severe pneumonia did not show differences in clinical outcome . Late failure ( > 72 h after admittance ) was more common in the prednisolone group ( 20 patients , 19.2 % ) than in the placebo group ( 10 patients , 6.4 % ; P = 0.04 ) . Adverse events were few and not different between the two groups . CONCLUSIONS Prednisolone ( at  
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Conclusions : In critically ill patients with sepsis , corticosteroids possibly result in a small reduction in mortality while also possibly increasing the risk of neuromuscular weakness