Hydrocortisone continuous infusion for septic shock shows no positive impact on glycaemic control

Continuous infusion (CI) hydrocortisone therapy in patients with septic shock is not associated with a beneficial impact on mean blood glucose or influence glycaemic variability as compared to bolus dose (BD) therapy, reports a study.

“Corticosteroid therapy in patients with septic shock can improve haemodynamics but can also cause hyperglycaemia,” the authors said. “CI hydrocortisone has limited evidence that it may reduce hyperglycaemia relative to BD therapy, but CI can be cumbersome and requires attention to intravenous access and drug incompatibilities.”

To compare the effects of CI hydrocortisone with BD on glycaemic control, the authors carried out a matched, retrospective cohort study of blood glucose, insulin requirements, and glycaemic variability between patients with shock receiving CI and BD hydrocortisone. They matched participants according to their history of type 2 diabetes and intensive care unit (ICU) admission.

Baseline blood glucose was comparable between the CI and BD groups, with the former having higher baseline hourly insulin requirements (12 vs 7 units; p=0.0012). There was no difference in mean blood glucose for the first 72 hours of treatment, with higher average hourly insulin requirement in the CI vs the BD group (7.8 vs 5.5 units; p<0.0001).

In addition, no between-group difference was observed in glycaemic variability.

A 2007 trial reported that CI hydrocortisone therapy for septic shock could help patients more easily achieve strict normoglycaemia. This approach also reduced nursing workload needed to maintain tight blood glucose control. [Crit Care 2007;11:R21]