Bolus or continuous hydrocortisone--that is the question.
Constantly evolving treatment guidelines based on a growing body of randomized controlled trials are helping us to improve outcomes in sepsis. However, it must be borne in mind that proven benefit from individual sepsis treatments does not guarantee synergistic beneficial effects when new treatments are added to sepsis management. Indeed, unexpected harmful interactions are also possible. A good example of this is the conflict between intensive insulin therapy and 'low dose' hydrocortisone in septic shock. The goal of tight glycaemic control is made more complicated by steroid-induced hyperglycaemia. In their recent study, Loisa and coworkers demonstrate a measure that reduces the risk for this interaction. They found continuous infusion of hydrocortisone to be associated with fewer hyperglycaemic episodes and reduced staff workload compared with bolus application.
Weber-Carstens
Steffen
S
Clinic of Anesthesiology and Intensive Care Medicine, Charité, Universitätsmedizin Berlin, Campus Virchow-Klinikum & Campus Mitte, Berlin, Germany. steffen.weber-carstens@charite.de
Keh
Didier
D
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage*; D006943:Hyperglycemia / Q000139:chemically induced; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D012772:Shock, Septic / Q000097:blood / Q000188:drug therapy*
D000893:Anti-Inflammatory Agents; D001786:Blood Glucose; D006854:Hydrocortisone