What steroid regimen do you use in patients with both septic shock and ARDS?

Personally, I have used Hydrocortisone 50mg q6h for patients with refractory shock, regardless of the presence of absence of ARDS.

I have not been an adopter of Steroids in ARDS.

I use the random cortisol level to determine relative versus actual adrenal insufficiency. Shock reversal is accelerated with hydrocortisone although I haven't experienced a huge survival benefit.