***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: Abstract Introduction Low-dose hydrocortisone treatment is widely accepted therapy for the treatment of vasopressor-dependent septic shock . The question of whether corticosteroids should be given to septic shock patients by continuous or by bolus infusion is still unanswered . Hydrocortisone induces hyperglycemia and it is possible that continuous hydrocortisone infusion would reduce the fluctuations in blood glucose levels and that tight blood glucose control could be better achieved with this approach . Methods In this prospect i ve r and omized study , we compared the blood glucose profiles , insulin requirements , amount of nursing workload needed , and shock reversal in 48 septic shock patients who received hydrocortisone treatment either by bolus or by continuous infusion with equivalent dose ( 200 mg/day ) . Duration of hydrocortisone treatment was five days . Results The mean blood glucose levels were similar in the two groups , but the number of hyperglycemic episodes was significantly higher in those patients who received bolus therapy ( 15.7 ± 8.5 versus 10.5 ± 8.6 episodes per patient , p = 0.039 ) . Also , more changes in insulin infusion rate were needed to maintain strict normoglycemia in the bolus group ( 4.7 ± 2.2 versus 3.4 ± 1.9 adjustments per patient per day , p = 0.038 ) . Hypoglycemic episodes were rare in both groups . No difference was seen in shock reversal . ConclusionS trict normoglycemia is more easily achieved if the hydrocortisone therapy is given to septic shock patients by continuous infusion . This approach also reduces nursing workload needed to maintain tight blood glucose control . Trial Registration Number IS RCT 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 CONTEXT Corticosteroid therapy induces potentially detrimental hyperglycemia in septic shock . In addition , the benefit of adding fludrocortisone in this setting is unclear . OBJECTIVES To test the efficacy of intensive insulin therapy in patients whose septic shock was treated with hydrocortisone  and to assess , as a secondary objective , the benefit of fludrocortisone . DESIGN , SETTING , AND PATIENTS A multicenter , 2 x 2 factorial , r and omized trial , involving 509 adults with septic shock who presented with multiple organ dysfunction , as defined by a Sequential Organ Failure Assessment score of 8 or more , and who had received hydrocortisone treatment was conducted from January 2006 to January 2009 in 11 intensive care units in France . INTERVENTIONS Patients were r and omly assigned to 1 of 4 groups : continuous intravenous insulin infusion with hydrocortisone alone , continuous intravenous insulin infusion with hydrocortisone plus fludrocortisone , conventional insulin therapy with hydrocortisone alone , or conventional insulin therapy with intravenous hydrocortisone plus fludrocortisone . Hydrocortisone was administered in a 50-mg bolus every 6 hours , and fludrocortisone was administered orally in 50-microg tablets once a day , each for 7 days . MAIN OUTCOME MEASURE In-hospital mortality . RESULTS Of the 255 patients treated with intensive insulin , 117 ( 45.9 % ) , and 109 of 254 ( 42.9 % ) treated with conventional insulin therapy died ( relative risk [ RR ] , 1.07 ; 95 % confidence interval [ CI ] , 0.88 - 1.30 ; P = .50 ) . Patients treated with intensive insulin experienced significantly more episodes of severe hypoglycemia ( < 40 mg/dL ) than those in the conventional-treatment group , with a difference in mean number of episodes per patient of 0.15 ( 95 % CI , 0.02 - 0.28 ; P = .003 ) . At hospital discharge , 105 of 245 patients treated with fludrocortisone ( 42.9 % ) died and 121 of 264 ( 45.8 % ) in the control group died ( RR , 0.94 ; 95 % CI , 0.77 - 1.14 ; P = .50 ) . CONCLUSIONS Compared with conventional insulin therapy , intensive insulin therapy did not improve in-hospital mortality among patients who were treated with hydrocortisone for septic shock . The addition of oral fludrocortisone did not result in a statistically significant improvement in in-hospital mortality . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00320099 BACKGROUND Clinical trials yielded conflicting data about the benefit of adding systemic corticosteroids for treatment of community-acquired pneumonia . We assessed whether short-term corticosteroid treatment reduces time to clinical stability in patients admitted to hospital for community-acquired pneumonia . METHODS In this double-blind , multicentre , r and omised , placebo-controlled trial , we recruited patients aged 18 years or older with community-acquired pneumonia from seven tertiary care hospitals in Switzerl and within 24 h of presentation . Patients were r and omly assigned ( 1:1 ratio ) to receive either prednisone 50 mg daily for 7 days or placebo . The computer-generated r and omisation was done with variable block sizes of four to six and stratified by study centre . The primary endpoint was time to clinical stability defined as time ( days ) until stable vital signs for at least 24 h , and analysed by intention to treat . This trial is registered with Clinical Trials.gov , number NCT00973154 . FINDINGS From Dec 1 , 2009 , to May 21 , 2014 , of 2911 patients assessed for eligibility , 785 patients were r and omly assigned to either the prednisone group ( n=392 ) or the placebo group ( n=393 ) . Median time to clinical stability was shorter in the prednisone group ( 3·0 days , IQR 2·5 - 3·4 ) than in the placebo group ( 4·4 days , 4·0 - 5·0 ; hazard ratio [ HR ] 1·33 , 95 % CI 1·15 - 1·50 , p<0·0001 ) . Pneumonia-associated complications until day 30 did not differ between groups ( 11 [ 3 % ] in the prednisone group and 22 [ 6 % ] in the placebo group ; odds ratio [ OR ] 0·49 [ 95 % CI 0·23 - 1·02 ] ; p=0·056 ) . The prednisone group had a higher incidence of in-hospital hyperglycaemia needing insulin treatment ( 76 [ 19 % ] vs 43 [ 11 % ] ; OR 1·96 , 95 % CI 1·31 - 2·93 , p=0·0010 ) . Other adverse events compatible with corticosteroid use were rare and similar in both groups . INTERPRETATION Prednisone treatment for 7 days in patients with community-acquired pneumonia admitted to hospital shortens time to clinical stability without an increase in complications . This finding is relevant from a patient perspective and an important determinant of hospital costs and efficiency . FUNDING Swiss National Science Foundation , Viollier AG , Nora van Meeuwen Haefliger Stiftung , Julia und Gottfried Bangerter-Rhyner Stiftung Introduction The benefit of corticosteroids as adjunctive treatment in patients with severe community-acquired pneumonia ( CAP ) requiring hospital admission remains unclear . This study aim ed to evaluate the impact of corticosteroid treatment on outcomes in patients with CAP . Methods This was a prospect i ve , double-blind and r and omized study . All patients received treatment with ceftriaxone plus levofloxacin and methyl-prednisolone ( MPDN ) administered r and omly and blindly as an initial bolus , followed by a tapering regimen , or placebo . Results Of the 56 patients included in the study , 28 ( 50 % ) were treated with concomitant corticosteroids . Patients included in the MPDN group show a more favourable evolution of the pO2/FiO2 ratio and faster decrease of fever , as well as greater radiological improvement at seven days . The time to resolution of morbidity was also significantly shorter in this group . Six patients met the criteria for mechanical ventilation ( MV ) : five in the placebo group ( 22.7 % ) and one in the MPDN group ( 4.3 % ) . The duration of MV was 13 days ( interquartile range 7 to 26 days ) for the placebo group and three days for the only case in the MPDN group . The differences did not reach statistical significance . Interleukin (IL)-6 and C-reactive protein ( CRP ) showed a significantly quicker decrease after 24 h of treatment among patients treated with MPDN . No differences in mortality were found among groups . Conclusions MPDN treatment , in combination with antibiotics , improves respiratory failure and accelerates the timing of clinical resolution of severe CAP needing hospital admission . Trial Registration International St and ard R and omized Controlled Trials Register , IS RCT N22426306 Purpose : The Surviving Sepsis Campaign guidelines recommend hydrocortisone in septic shock only when fluid resuscitation and vasopressors fail to restore hemodynamic stability . Hydrocortisone administration modalities are supported only by low- grade recommendations . Our main objective here was to determine differences in 28-day mortality between two low-dose hydrocortisone regimens for the treatment of septic shock . Methods : We performed a multicenter , prospect i ve , r and omized , double-blind , pilot study in four adult medical intensive care units . Patients presenting septic shock were rapidly administered one of two regimens of hydrocortisone , either a 50-mg intravenous bolus every 6 h during 7 days ( 200-mg group ; n = 59 ) or a 100-mg initial bolus followed by a continuous infusion of 300 mg daily for 5 days ( 300-mg group ; n = 63 ) . Hydrocortisone was stopped abruptly at the end of treatment . Results : There were no significant differences between the 200-mg and 300-mg groups as concerns 28-day mortality ( respectively 52.5 % vs. 44.4 % [ RR 0.84 , 95 % CI , 0.58–1.22 , P = 0.47 ] ) , refractory shock incidence or delay from shock to vasopressor cessation . There were also no differences in adverse events between the groups . Shock relapse after hydrocortisone cessation was independent of hydrocortisone regimens , but it was associated with the persistence of infection and the use of etomi date . The resumption of hydrocortisone due to shock relapse was significantly more frequent in the 300-mg group . Conclusion : We found no differences in mortality or adverse events between the two hydrocortisone administration regimens . Shock relapse was significantly associated with the persistence of infection and the use of etomi date 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 
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Moderate-certainty evidence shows that there is probably little or no difference in gastroduodenal bleeding , stroke , or cardiac events , and low-certainty evidence suggests that corticosteroids may result in little to no difference in neuropsychiatric events .
Moderate-certainty evidence indicates that corticosteroids probably reduce 28-day and hospital mortality among patients with sepsis .
Corticosteroids result in large reductions in ICU and hospital length of stay ( high-certainty evidence ) .
There may be little or no difference in the risk of major complications ; however , corticosteroids increase the risk of muscle weakness and hypernatraemia , and probably increase the risk of hyperglycaemia .
The effects of continuous versus intermittent bolus administration of corticosteroids are uncertain