Septic shock: bolus steroids beat continuous infusion

  • Tilouche N & al.
  • Shock
  • 1 Nov 2019

  • International Clinical Digest
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Takeaway

  • This very small open-label trial found that for patients in septic shock, bolus administration of hydrocortisone led to higher rates of shock reversal vs continuous infusion.

Why this matters

  • 60% of patients with septic shock experience relative adrenal insufficiency, a condition linked to worse prognoses.
  • The Surviving Sepsis Campaign does not specify whether patients eligible for steroids for septic shock should receive it via bolus or continuous infusion, according to authors.

Key results

  • Bolus vs continuous group:
    • Shock reversal at day 7: 66% (22/33) vs 35% (13/37; P=.008).
    • Shock reversal at day 7, excluding early deaths: 75% (22/29) vs 44% (13/29; P=.01).
    • 28-day mortality: no difference.

Study design

  • Single-ICU randomised controlled open-label trial (n=58).
  • Adults receiving norepinephrine for septic shock were randomly assigned to receive hydrocortisone 200 mg/day by continuous infusion vs by 50 mg boluses every 6 hours.
  • Outcome: shock reversal at day 7.
  • Funding: None disclosed.

Limitations

  • Small sample size.
  • Inadequate information to assess blood glucose and insulin requirements.