Effect of Continuous Infusion vs Bolus Dose of Hydrocortisone in Septic Shock: A Prospective Randomized Study.

IF 1.5 Q3 CRITICAL CARE MEDICINE Indian Journal of Critical Care Medicine Pub Date : 2024-09-01 Epub Date: 2024-08-31 DOI:10.5005/jp-journals-10071-24793
Rashmi Salhotra, Ajeeb Sharahudeen, Asha Tyagi, Rajesh S Rautela, Rajit Kemprai
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Abstract

Aim and background: Corticosteroids are recommended for use in adult patients with septic shock requiring vasopressors for blood pressure maintenance. However, this predisposes them to hyperglycemia, which is associated with a poor outcome. This prospective randomized study compares the effect of continuous infusion with bolus hydrocortisone on blood glucose levels in septic shock.

Materials and methods: Forty adult patients with sepsis and septic shock requiring vasopressor support were randomly allocated to either group C (continuous infusion of hydrocortisone 200 mg/day) or group B (intermittent bolus dose of hydrocortisone 50 mg IV 6 hourly). Blood glucose level (primary objective), number of hyperglycemic and hypoglycemic episodes, daily insulin requirement, shock reversal incidence, time to shock reversal, and nursing workload required to maintain blood glucose within the target range (82-180 mg/dL) were compared.

Results: The mean blood glucose level was comparable in the two groups (136.5 ± 22.08 mg/dL in group C vs 135.85 ± 19.06 mg/dL in group B; p = 0.921). The number of hyperglycemic and hypoglycemic episodes (p = 1.000 each), insulin requirement/day (p = 1.000), and nursing workload (p = 0.751) were also comparable among groups. Shock reversal was seen in 7/20 (35%) patients in continuous group and 12/20 (60%) patients in bolus group (p = 0.113). Time to shock reversal (p = 0.917) and duration of ICU stay (p = 0.751) were also statistically comparable.

Conclusion: Both the regimes of hydrocortisone, continuous infusion, and bolus dose, have comparable effects on blood glucose levels in patients with septic shock.The study was registered prospectively with ctri.nic.in (Ref. No. CTRI/2021/01/030342; registered on 8/1/2021).

How to cite this article: Salhotra R, Sharahudeen A, Tyagi A, Rautela RS, Kemprai R. Effect of Continuous Infusion vs Bolus Dose of Hydrocortisone in Septic Shock: A Prospective Randomized Study. Indian J Crit Care Med 2024;28(9):837-841.

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脓毒性休克中持续输注与注射氢化可的松的效果:一项前瞻性随机研究。
目的和背景:建议对需要使用血管加压剂维持血压的脓毒性休克成人患者使用皮质类固醇。然而,这容易导致高血糖,而高血糖与不良预后有关。这项前瞻性随机研究比较了持续输注和栓塞氢化可的松对脓毒性休克患者血糖水平的影响:40 名需要血管加压支持的脓毒症和脓毒性休克成人患者被随机分配到 C 组(连续输注氢化可的松 200 毫克/天)或 B 组(间歇性栓剂氢化可的松 50 毫克静脉注射,每 6 小时一次)。比较血糖水平(主要目标)、高血糖和低血糖发作次数、每日胰岛素需求量、休克逆转发生率、休克逆转时间以及将血糖维持在目标范围(82-180 毫克/分升)所需的护理工作量:两组的平均血糖水平相当(C 组为 136.5 ± 22.08 mg/dL vs B 组为 135.85 ± 19.06 mg/dL; p = 0.921)。各组的高血糖和低血糖发作次数(p = 1.000)、胰岛素需求量/天(p = 1.000)和护理工作量(p = 0.751)也相当。连续用药组有 7/20 例(35%)患者出现休克逆转,栓剂用药组有 12/20 例(60%)患者出现休克逆转(p = 0.113)。休克逆转时间(p = 0.917)和重症监护室住院时间(p = 0.751)在统计学上也具有可比性:该研究在ctri.nic.in进行了前瞻性登记(编号:CTRI/2021/01/030342;登记日期:2021年1月8日):Salhotra R, Sharahudeen A, Tyagi A, Rautela RS, Kemprai R.脓毒性休克持续输注与静脉注射氢化可的松的效果:前瞻性随机研究。Indian J Crit Care Med 2024;28(9):837-841.
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来源期刊
CiteScore
3.50
自引率
10.00%
发文量
299
期刊介绍: Indian Journal of Critical Care Medicine (ISSN 0972-5229) is specialty periodical published under the auspices of Indian Society of Critical Care Medicine. Journal encourages research, education and dissemination of knowledge in the fields of critical and emergency medicine.
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