The administration of a continuous infusion of hydrocortisone to a general population of patients in septic shock on mechanical ventilation cannot be recommended at this time. The authors conclusion that glucocorticoids do not improve mortality in septic shock is a reasonable assessment. What conclusion we can draw from the secondary outcomes is less clear. It is hard to view these results as anything but a negative study. While there are some potential signals of benefit in the patients who received hydrocortisone, they were fleeting and ultimately had minimal influence on patient centered outcomes. If a true benefit does exist, it is small and would require an impossibly large trial to empirically demonstrate.

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