Faculty Opinions recommendation of Hydrocortisone therapy for patients with septic shock.

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Abstract
This high-quality multicentre study reminds us that clinicians must have an open mind when applying guidelines and recommendations. Its results are indeed challenging the generalisation that has been made of the results reported by Annane et al. {1}. Although the study does not allow us to reject the use of steroids for all patients with septic shock, it does force us to think carefully about the appropriate indication. The authors reported that hydrocortisone 50mg every six hours for five days, followed by a progressive decrease over six days, did not improve outcome in patients with septic shock. The authors studied what might be the current practice in many intensive care units, and while their results do not allow a definite answer on the issue, they raise the question of 'universal embrace' of recommendations when scientific evidence is lacking. With the advent of guidelines imposed upon our practices by external bodies, and sometimes inappropriate surrogate markers making us believe that we do right, we should remind ourselves that only properly designed trials will help us answer the impact of specific practice on the well-being of our patients.

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