Indications for corticosteroid use in septic shock. Three scenarios were evaluated. Blood pressure: whether blood pressure is identified to be poorly responsive to fluid resuscitation and vasopressor therapy. Adrenocorticotropic hormone (ACTH): whether there is an inappropriate response to a high-dose ACTH stimulation test (change in cortisol <9 μg/dl). History: whether the patient has been treated previously with corticosteroids (within the previous 6 months). Concordance with Surviving Sepsis Guidelines: 88% for blood pressure, 47% for ACTH and 62% for history.