Comparison Between Continuous and Intermittent Administration of Hydrocortisone During Septic Shock: A Randomized Controlled Clinical Trial
| Autor: | R. Gharbi, Mohamed Fekih Hassen, Nejla Tilouche, Oussama Jaoued, Souheil Elatrous, Habiba Ben Sik Ali |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Hydrocortisone Continuous infusion 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine law.invention 03 medical and health sciences 0302 clinical medicine Bolus (medicine) Randomized controlled trial law medicine Humans Aged Septic shock business.industry 030208 emergency & critical care medicine Middle Aged bacterial infections and mycoses medicine.disease Shock Septic Clinical trial Intensive Care Units Anesthesia Emergency Medicine Female business medicine.drug |
| Zdroj: | Shock. 52:481-486 |
| ISSN: | 1540-0514 1073-2322 |
| Popis: | The best modality of administration of hydrocortisone during septic shock has been poorly evaluated and the guidelines remain unclear in this respect. This study aimed to compare bolus of hydrocortisone to a continuous infusion during septic shock.Randomized controlled, open-label trial.Medical ICU of a university hospital.Adult patients with septic shock requiring more than 2 mg/h (approximately 33.3 μg/mn) of norepinephrine after adequate fluid administration were eligible.Patients already receiving corticosteroids or who have a contraindication to corticosteroids, patients who died within 24 h and those with a decision of not to resuscitate were excluded.Patients were randomized either to receive hydrocortisone 200 mg/d by continuous infusion or by boluses of 50 mg every 6 h throughout the prescription of vasopressors with a maximum of 7 days.Twenty-nine patients were included in each group. Shock reversal was significantly higher in the HC bolus group (66% vs. 35%, P = 0.008). The median time to shock reversal was 5 days (95% CI, 4.31-5.69) in the HC bolus group compared to 6 days (95% CI, 4.80-7.19) in the HC continuous infusion group (log Rank = 0.048). The number of hours spent with blood glucose ≥ 180 mg/dL was higher in the HC continuous infusion group with a median of 64 h [IQR (2-100)] versus 48 h [IQR (14-107)] in the HC bolus group, (P = 0.60), and daily insulin requirements were similar between the two groups (P = 0.63). The occurrence of other side effects, mortality, and ICU LOS were similar between the study groups.Hydrocortisone administered by intermittent bolus was associated with higher shock reversal at day 7 compared with a continuous infusion. |
| Databáze: | OpenAIRE |
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