Firstly, thank you to the authors for their time and participation and to the NEJM Resident 360 Journal club for the opportunity to facilitate the discussion. In reviewing the ADRENAL trial and their primary outcome measure of 90-day all-cause mortality, continuous infusion of glucocorticoids did not show a mortality benefit. This is in-line with previous trials such as CORTICUS and HYPRESS. Despite this, in the ADRENAL trial there were some secondary outcomes (i.e., shorter ICU stay and shorter duration of mechanical ventilation) that did suggest beneficial effects of steroids. Given these outcomes, in your own practice, do you feel there is a role for adjunctive steroids in patients with refractory shock?
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