Research

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

Pekka Loisa¹ , Ilkka Parviainen² , Jyrki Tenhunen³ , Seppo Hovilehto⁴ and Esko Ruokonen²

¹  Department of Intensive Care, Päijät-Häme Central Hospital, Keskussairaalankatu 7, FI 15850 Lahti, Finland

²  Department of Intensive Care, Kuopio University Hospital, P.O. Box 1777, FI 70211 Kuopio, Finland

³  Department of Intensive Care, Tampere University Hospital, P.O. Box 2000, FI 33521 Tampere, Finland

⁴  Department of Intensive Care, South Carelian Central Hospital, Valto Käkelän katu 1, FI 53130 Lappeenranta, Finland

author email corresponding author email

Critical Care 2007, 11:R21doi:10.1186/cc5696

Published:	16 February 2007

See related commentary by Weber-Carstens and Keh, http://ccforum.com/content/11/1/113

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.

Trial Registration Number

ISRCTN98820688