Objective

This matched, retrospective cohort study compares continuous infusion hydrocortisone therapy to bolus dose hydrocortisone therapy for critically ill patients with septic shock, and specifically examines glycemic control outcomes (intravenous insulin managed with EndoTool).

Setting

900-bed tertiary care regional referral center with 128 critical care beds.

Results

• Mean insulin requirements were higher with continuous infusion hydrocortisone therapy than with bolus dose hydrocortisone therapy (7.8 vs. 5.5 units/hour).
• There were no statistically significant differences between continuous infusion hydrocortisone therapy and bolus dose hydrocortisone therapy for other glycemic control outcomes: mean blood glucose over the first 72 hours was 141.2 mg/dL and 144.5 mg/dL, respectively; mean time spent within the goal range was 19.8 hours and 20.02 hours, respectively; mean glucose variability was 25.6 SD and 25.9 SD, respectively; incidence of hypoglycemia <70 mg/dL was 1.4% and 1.1% of blood glucose readings, respectively; and incidence of hyperglycemia >200 mg/dL was 5.7% and 6.7% of blood glucose readings, respectively.

Conclusions

Though patients receiving continuous infusion hydrocortisone therapy may have higher insulin requirements at baseline than patients receiving bolus dose hydrocortisone therapy, there are no significant differences in glycemic control outcomes; therefore, given the potential complexities associated with continuous infusion hydrocortisone therapy and increased use of resources, it is reasonable for clinicians to safely use bolus dose hydrocortisone therapy for critically ill patients with septic shock.