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Hydrocortisone by Continuous Infusion Favored for Septic Shock Patients
NEW YORK (Reuters Health) Feb 23 - Continuous infusion of hydrocortisone offers advantages over bolus administration in patients with septic shock, according to a February 16th online report in Critical Care.
"This is the first study that has compared bolus versus continuous hydrocortisone infusion in the treatment of septic shock," Dr. Pekka Loisa from Paijat-Hame Central Hospital, Lahti, Finland told Reuters Health. "Minor differences (favoring continuous infusion) can be observed in the glycemic control between these two regimens."
Dr. Loisa and colleagues investigated how the two corticosteroid treatment modalities would influence glucose profiles in septic shock and compared the reversal of shock and nursing workload needed between the two regimens. The study involved 48 patients who received 200 mg/day hydrocortisone either as a continuous infusion or by 50-mg bolus every 6 hours.
Mean daily blood glucose levels, insulin requirements, and calorie intake were similar between the two treatment groups (bolus administration and continuous infusion), the researchers report.
Despite similar mean blood glucose levels, they say, hyperglycemic episodes were significantly more common in the bolus group than in the continuous infusion group. There were also more hypoglycemic episodes in the bolus group (3 episodes) than in the continuous infusion group (1 episode).
Nursing workload needed to maintain normoglycemia was higher in the bolus group due to an increased number of insulin infusion rate adjustments, the results indicate.
The reversal of shock did not differ between the study groups, the report shows. Overall ICU mortality was 23%, with 4 deaths from refractory hypotension in the continuous infusion group and 2 such deaths in the bolus group.
"Our findings suggest that, in septic shock, strict normoglycemia is more easily achieved with continuous hydrocortisone infusion," the investigators conclude. "However, the differences between the study groups were rather marginal and in both groups the normoglycemic goal could be achieved quite successfully."
"There was a tendency that the amount of insulin needed, adjusted to administered calories, was lower in the infusion treated patients throughout the study period," Dr. Loisa said. "Unfortunately this difference was not statistically significant, but it may reflect that the insulin resistance is resolved more rapidly in those patients who received hydrocortisone by continuous infusion."
Crit Care 2007;11:R21.
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