Objectives: The best modality of administration of hydrocortisone during septic shock has been poorly evaluated and the guidelines remain unclear in this respect. This study aimed to compare bolus of hydrocortisone to a continuous infusion during septic shock.
Design: Randomized controlled, open-label trial.
Setting: Medical ICU of a university hospital.
Patients: Adult patients with septic shock requiring more than 2 mg/h (approximately 33.3 μg/mn) of norepinephrine after adequate fluid administration were eligible.Patients already receiving corticosteroids or who have a contraindication to corticosteroids, patients who died within 24 h and those with a decision of not to resuscitate were excluded.
Interventions: Patients were randomized either to receive hydrocortisone 200 mg/d by continuous infusion or by boluses of 50 mg every 6 h throughout the prescription of vasopressors with a maximum of 7 days.
Results: Twenty-nine patients were included in each group. Shock reversal was significantly higher in the HC bolus group (66% vs. 35%, P = 0.008). The median time to shock reversal was 5 days (95% CI, 4.31-5.69) in the HC bolus group compared to 6 days (95% CI, 4.80-7.19) in the HC continuous infusion group (log Rank = 0.048). The number of hours spent with blood glucose ≥ 180 mg/dL was higher in the HC continuous infusion group with a median of 64 h [IQR (2-100)] versus 48 h [IQR (14-107)] in the HC bolus group, (P = 0.60), and daily insulin requirements were similar between the two groups (P = 0.63). The occurrence of other side effects, mortality, and ICU LOS were similar between the study groups.
Conclusion: Hydrocortisone administered by intermittent bolus was associated with higher shock reversal at day 7 compared with a continuous infusion.
Evaluation of Hydrocortisone Continuous Infusion Versus Intermittent Boluses in Resolution of Septic ShockH Hoang et al. P T 42 (4), 252-255. PMID 28381918.There was no significant difference in time to resolution of septic shock between continuous infusion (200 mg per day) and intermittent boluses (50 mg every six hours) of …
Timing, Method and Discontinuation of Hydrocortisone Administration for Septic Shock PatientsMA Ibarra-Estrada et al. World J Crit Care Med 6 (1), 65-73. PMID 28224109.Continuous infusion of hydrocortisone could hasten the resolution of septic shock compared to bolus administration. Earlier initiation corresponds with a higher probabili …
Effect of Mode of Hydrocortisone Administration on Glycemic Control in Patients With Septic Shock: A Prospective Randomized TrialP Loisa et al. Crit Care 11 (1), R21. PMID 17306016. - Randomized Controlled TrialStrict normoglycemia is more easily achieved if the hydrocortisone therapy is given to septic shock patients by continuous infusion. This approach also reduces nursing wo …
Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012RP Dellinger et al. Crit Care Med 41 (2), 580-637. PMID 23353941.Strong agreement existed among a large cohort of international experts regarding many level 1 recommendations for the best care of patients with severe sepsis. Although a …
Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2008RP Dellinger et al. Crit Care Med 36 (1), 296-327. PMID 18158437.There was strong agreement among a large cohort of international experts regarding many level 1 recommendations for the best current care of patients with severe sepsis. …
Cited by 1 PubMed Central articles
Corticosteroids for Treating Sepsis in Children and AdultsD Annane et al. Cochrane Database Syst Rev 12 (12), CD002243. PMID 31808551. - ReviewModerate-certainty evidence indicates that corticosteroids probably reduce 28-day and hospital mortality among patients with sepsis. Corticosteroids result in large reduc …