Hydrocortisone Continuous Infusion Versus Bolus Dose on Glycemic Control in Critically Ill Subjects

Background: Corticosteroid therapy in patients with septic shock can improve hemodynamics but can also cause hyperglycemia. Continuous infusion (CI) hydrocortisone has limited evidence that it may reduce hyperglycemia relative to bolus dose (BD) therapy, but CI can be cumbersome and requires attention to intravenous access and drug incompatibilities. Objective: To compare the effects of CI hydrocortisone with BD on glycemic control. Methods: A matched, retrospective cohort study of blood glucose, insulin requirements, and glycemic variability was performed between patients with shock receiving CI and BD hydrocortisone. Patients were matched based on history of type 2 diabetes and intensive care unit (ICU) admission. Results: Baseline blood glucose was similar between groups, with higher baseline hourly insulin requirements in the CI group (CI: 12 [12.8] units, BD: 6.7 [7] units, P = .0012). For the first 72 hours of treatment, there was no difference in mean blood glucose with higher average hourly insulin requirements in the CI group (CI 7.8 [7.7] units, BD: 5.5 [6.9] units, P < .0001). There was no difference in glycemic variability between groups. Conclusions: CI hydrocortisone therapy for septic shock does not appear to have a favorable impact on mean blood glucose or influence glycemic variability relative to BD therapy.