An International Survey of Corticosteroid Use in Septic Shock

Background: Corticosteroid use in septic shock remains variable in clinical practice. Uncertainty persists regarding the role of fludrocortisone. Research Question: What are current clinician self-reported practices and beliefs about optimal corticosteroid use in septic shock? Study Design and Methods: We conducted a cross-sectional survey of critical care practitioners within the Society of Critical Care Medicine and the Canadian Critical Care Society from May through August 2025 to characterize current self-reported practices and beliefs regarding optimal corticosteroid regimens and the need for further randomized controlled trials for corticosteroid regimens in critical illness. Results: We found 14,814 individuals to be eligible for the survey. The survey response rate was 5.8% (n = 861). Most respondents (87%) were from the United States; 33 countries were represented. A diversity of practice type, clinical role, base specialty, and years of experience was reported. Thirty-nine percent of respondents reported always or almost always prescribing corticosteroids for vasopressor-dependent septic shock, and 12% of respondents always or almost always coprescribed fludrocortisone. Seventy-six percent of respondents use a threshold such as ≥ 0.1 to 0.25 μg/kg/min norepinephrine equivalents as a trigger to initiate corticosteroids. A wide range of beliefs in the efficacy or nonefficacy of both glucocorticoids and mineralocorticoids was reported. Most respondents (91%) were receptive to future randomized trials examining the role of fludrocortisone in patients with acute hypoxemic respiratory failure with or without sepsis. Interpretation: Our results show that substantial variability exists in self-reported practices and beliefs regarding optimal corticosteroid regimens. Future investigations should evaluate factors for decision-making in prescribing corticosteroids for patients with septic shock.