Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2007;11(1):R21.
doi: 10.1186/cc5696.

Effect of mode of hydrocortisone administration on glycemic control in patients with septic shock: a prospective randomized trial

Pekka Loisa  1 , Ilkka Parviainen, Jyrki Tenhunen, Seppo Hovilehto, Esko Ruokonen
Affiliations
Randomized Controlled Trial

Effect of mode of hydrocortisone administration on glycemic control in patients with septic shock: a prospective randomized trial

Pekka Loisa et al. Crit Care. 2007.

Abstract

Introduction: 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.

Conclusion: 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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow diagram of the study. GI, gastrointestinal.
Figure 2
Figure 2
Blood glucose levels (mean ± standard deviation) in the study groups. P values represent the difference between the study groups (analysis of variance).
Figure 3
Figure 3
Insulin requirements (mean ± standard deviation) in the study groups. P values represent the difference between the study groups (analysis of variance).
Figure 4
Figure 4
Intake of calories (mean ± standard deviation) in the study groups. P values represent the difference between the study groups (analysis of variance).
Figure 5
Figure 5
Insulin requirements adjusted to administered calories (mean ± standard deviation) in the study groups. P values represent the difference between the study groups (analysis of variance).
See this image and copyright information in PMC

Comment in

References

    1. Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, Gea-Banacloche J, Keh D, Marshall JC, Parker MM, et al. Surviving sepsis campaign guidelines for management of severe sepsis and septic shock. Intensive Care Med. 2004;30:536–555. doi: 10.1007/s00134-004-2398-y. - DOI - PubMed
    1. Bollaert PE, Charpentier C, Levy B, Depouverie M, Audibert G, Larcan A. Reversal of late septic shock with supraphysiologic doses of hydrocortisone. Crit Care Med. 1998;26:645–650. doi: 10.1097/00003246-199804000-00010. - DOI - PubMed
    1. Briegel J, Forst H, Haller M, Schelling G, Kilger E, Kuprat G, Hemmer B, Hummel T, Lenhart A, Heyduck M, et al. Stress doses of hydrocortisone reverses hyperdynamic septic shock: a prospective, randomized, double-blind, single-center study. Crit Care Med. 1999;27:723–732. doi: 10.1097/00003246-199904000-00025. - DOI - PubMed
    1. Annane D, Sebille V, Charpentier C, Bollaert PE, Francois B, Korach JM, Capellier G, Cohen Y, Azoulay E, Troche G, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA. 2002;288:862–871. doi: 10.1001/jama.288.7.862. - DOI - PubMed
    1. Keh D, Sprung CL. Use of corticosteroid therapy in patients with sepsis and septic shock: an evidence-based review. Crit Care Med. 2004;32(11 Suppl):S527–S533. doi: 10.1097/01.CCM.0000142983.15421.11. - DOI - PubMed

Publication types

MeSH terms

Associated data