Cortisol replacement for severe sepsis and septic shock: what should I do?

Based on several recently completed randomized controlled trials, cortisol replacement is likely to become a standard of care for vasopressor dependent septic shock. Further studies are needed in order to accomplish whether this treatment should be limited to patients with a blunted cortisol response to corticotrophin. Similarly, in patients with severe sepsis who do not need vasopressors, the benefit/risk ratio of cortisol replacement remains to be assessed.