Reducing Septic Shock Hyperglycemia with Hydrocortisone

Continuous infusion of low-dose hydrocortisone reduces hyperglycemia more easily in patients with septic shock, according to a new study.

Researchers from the Päijät-Häme Central Hospital (Lahti, Finland), Kuopio University Hospital (Kuopio, Finland), and colleagues from other hospitals throughout Finland carried out a randomized controlled clinical 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 200 mg/day. The bolus therapy group of 24 patients received the same overall dose, but the hydrocortisone was administered intravenously in 50 mg doses every six hours. Hydrocortisone treatment lasted five days in both groups. The researchers compared blood glucose levels, insulin requirements, and the nursing workload for the two groups.

The researchers found that the mean blood glucose levels were similar in both groups, but the number of hyperglycemic 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 stressed, however, that normal blood glucose levels can be achieved successfully using both methods. The study was published in the January 2007 issue of the journal Critical Care.

"Our findings suggest that, in septic shock, strict normoglycemia is more easily achieved with continuous hydrocortisone infusion. However, the differences between the study groups were rather marginal, and in both groups the normoglycemic goal could be achieved quite successfully. This approach also reduces nursing workload needed to maintain tight blood glucose control,” concluded lead author Dr. Pekka Loisa, from the department of intensive care at Päijät-Häme Central Hospital.


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