Effect of mode of hydrocortisone administration on glycemic control in patients with septic shock: a prospective randomized trial.
BACKGROUND
Low-dose hydrocortisone treatment is widely accepted therapy for the treatment of vasopressor-dependent septic shock. The question of whether corticosteroids should be given to septic shock patients by continuous or by bolus infusion is still unanswered. Hydrocortisone induces hyperglycemia and it is possible that continuous hydrocortisone infusion would reduce the fluctuations in blood glucose levels and that tight blood glucose control could be better achieved with this approach.


METHODS
In this prospective randomized study, we compared the blood glucose profiles, insulin requirements, amount of nursing workload needed, and shock reversal in 48 septic shock patients who received hydrocortisone treatment either by bolus or by continuous infusion with equivalent dose (200 mg/day). Duration of hydrocortisone treatment was five days.


RESULTS
The mean blood glucose levels were similar in the two groups, but the number of hyperglycemic episodes was significantly higher in those patients who received bolus therapy (15.7 +/- 8.5 versus 10.5 +/- 8.6 episodes per patient, p = 0.039). Also, more changes in insulin infusion rate were needed to maintain strict normoglycemia in the bolus group (4.7 +/- 2.2 versus 3.4 +/- 1.9 adjustments per patient per day, p = 0.038). Hypoglycemic episodes were rare in both groups. No difference was seen in shock reversal.


CONCLUSIONS
Strict normoglycemia is more easily achieved if the hydrocortisone therapy is given to septic shock patients by continuous infusion. This approach also reduces nursing workload needed to maintain tight blood glucose control.
Loisa
Pekka
P
Department of Intensive Care, Päijät-Häme Central Hospital, Keskussairaalankatu 7, Lahti, Finland. pekka.loisa@phsotey.fi
Parviainen
Ilkka
I
Tenhunen
Jyrki
J
Hovilehto
Seppo
S
Ruokonen
Esko
E
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage* / Q000009:adverse effects; D006943:Hyperglycemia / Q000139:chemically induced* / Q000517:prevention & control; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D011446:Prospective Studies; D012772:Shock, Septic / Q000097:blood / Q000188:drug therapy* / Q000401:mortality
D000893:Anti-Inflammatory Agents; D001786:Blood Glucose; D006854:Hydrocortisone