Crit Care. 2007;11(1):113.

Bolus or continuous hydrocortisone--that is the question.

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Clinic of Anesthesiology and Intensive Care Medicine, Charité, Universitätsmedizin Berlin, Campus Virchow-Klinikum & Campus Mitte, Berlin, Germany. steffen.weber-carstens@charite.de

Abstract

Constantly evolving treatment guidelines based on a growing body of randomized controlled trials are helping us to improve outcomes in sepsis. However, it must be borne in mind that proven benefit from individual sepsis treatments does not guarantee synergistic beneficial effects when new treatments are added to sepsis management. Indeed, unexpected harmful interactions are also possible. A good example of this is the conflict between intensive insulin therapy and 'low dose' hydrocortisone in septic shock. The goal of tight glycaemic control is made more complicated by steroid-induced hyperglycaemia. In their recent study, Loisa and coworkers demonstrate a measure that reduces the risk for this interaction. They found continuous infusion of hydrocortisone to be associated with fewer hyperglycaemic episodes and reduced staff workload compared with bolus application.

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Crit Care. 2007;11(1):R21.

PMID:: 17316466; [PubMed - indexed for MEDLINE]
PMCID: PMC2151867

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Effect of mode of hydrocortisone administration on glycemic control in patients with septic shock: a prospective randomized trial. [Crit Care. 2007]
Effect of mode of hydrocortisone administration on glycemic control in patients with septic shock: a prospective randomized trial.
Loisa P, Parviainen I, Tenhunen J, Hovilehto S, Ruokonen E. Crit Care. 2007; 11(1):R21.
Corticosteroid treatment and intensive insulin therapy for septic shock in adults: a randomized controlled trial. [JAMA. 2010]
Corticosteroid treatment and intensive insulin therapy for septic shock in adults: a randomized controlled trial.
COIITSS Study Investigators, Annane D, Cariou A, Maxime V, Azoulay E, D'honneur G, Timsit JF, Cohen Y, Wolf M, Fartoukh M, et al. JAMA. 2010 Jan 27; 303(4):341-8.
Impact of bolus application of low-dose hydrocortisone on glycemic control in septic shock patients. [Intensive Care Med. 2007]
Impact of bolus application of low-dose hydrocortisone on glycemic control in septic shock patients.
Weber-Carstens S, Deja M, Bercker S, Dimroth A, Ahlers O, Kaisers U, Keh D. Intensive Care Med. 2007 Apr; 33(4):730-3. Epub 2007 Feb 27.
Review The current management of septic shock. [Minerva Med. 2008]
Review The current management of septic shock.
Russel JA. Minerva Med. 2008 Oct; 99(5):431-58.
Review Glucose control in sepsis. [Clin Chest Med. 2008]
Review Glucose control in sepsis.
Thompson BT. Clin Chest Med. 2008 Dec; 29(4):713-20, x.

See reviews... See all...

Chemical compound information

Hydrocortisone

MW: 362.45 g/mol

MF: C₂₁H₃₀O₅

See 6 citations for this compound....

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