Effect of hydrocortisone treatment modality on glycemic control in patients with septic shock

Changing how critically ill patients are treated with hydrocortisone could reduce hyperglycemia.

The results of a randomized controlled clinical trial, published today in the journal Critical Care, lead researchers to recommend using continuous infusion of low-dose hydrocortisone in patients with sepsis, rather than bolus injections. The study shows that continuous infusion of low-dose hydrocortisone minimizes hyperglycaemic episodes, serious adverse events that can lead to insulin dependency. The researchers also found that continuous infusion reduced nurses' workload.

Low dose hydrocortisone treatment is widely used as a treatment for patients suffering from septic shock. However, hydrocortisone stimulates glucose production in the liver and other tissues and may induce high blood glucose levels, or hyperglycaemia. Preventing hyperglycaemia has previously been shown to improve the survival of critically ill patients.

Pekka Loisa of the Paijat-Hame Hospital in Finland, and colleagues from hospitals throughout Finland carried out the trial involving 48 patients in four intensive care units (ICUs) between July 2005 and April 2006. One group of 24 patients received the hydrocortisone treatment by continuous infusion of 200mg/day. The bolus therapy group of 24 patients received the same overall dose, but the hydrocortisone was administered intravenously in 50mg doses every six hours. Loisa et al. compared blood glucose levels, insulin requirements and the nursing workload for the two groups. Hydrocortisone treatment lasted five days in both groups.

Loisa et al. found that the mean blood glucose levels were similar in both groups, but the number of hyperglycaemic episodes was higher in the group receiving bolus therapy. For patients undergoing bolus therapy, the insulin infusion rate had to be changed more often to maintain normal blood glucose levels, adding to nurses' workload. The researchers stress that normal blood glucose levels can be achieved successfully using both methods. However, strict normoglycemia is more easily achieved with continuous hydrocortisone infusion.

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