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Hydrocortisone Weaning Post-Sepsis — FRCA Final MCQ

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ModerateIntensive Care MedicineHydrocortisone Weaning Post-SepsisFRCA Final

A 60-year-old man (ASA III) on the ICU has been treated for septic shock with noradrenaline and hydrocortisone. His shock has resolved (vasopressors stopped 24 hours ago). How should the hydrocortisone be discontinued?

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Correct answer: A — Switch to oral prednisolone permanently

When hydrocortisone stress-dose therapy for septic shock is no longer needed (vasopressors stopped, clinical improvement), the steroid should be tapered rather than stopped abruptly. While the evidence is not definitive, gradual weaning over 2-5 days reduces the risk of: rebound hypotension, return of vasopressor dependence, and relative adrenal insufficiency from HPA axis suppression. A common regimen: reduce by 50 mg/day every 1-2 days until stopped, or switch to physiological replacement (hydrocortisone 20 mg mane, 10 mg nocte) and taper. Some centres do stop abruptly if the course was <3 days.

Reference: SSC – 2021 – International guidelines; ICS – 2023 – Steroid use in ICU