Abstract
Constantly evolving treatment guidelines based on a growing body of randomized controlled trials are helping us to improve outcomes in sepsis. However, it must be borne in mind that proven benefit from individual sepsis treatments does not guarantee synergistic beneficial effects when new treatments are added to sepsis management. Indeed, unexpected harmful interactions are also possible. A good example of this is the conflict between intensive insulin therapy and 'low dose' hydrocortisone in septic shock. The goal of tight glycaemic control is made more complicated by steroid-induced hyperglycaemia. In their recent study, Loisa and coworkers demonstrate a measure that reduces the risk for this interaction. They found continuous infusion of hydrocortisone to be associated with fewer hyperglycaemic episodes and reduced staff workload compared with bolus application.
Highlights
In this issue of Critical Care, Loisa and coworkers [1] present the first randomized controlled trial on the influence of mode of hydrocortisone administration on glycaemic control in patients with septic shock
Stress-induced hyperglycaemia and reduced insulin sensitivity are the primary disorders of glucose metabolism in severe sepsis, iatrogenic hypoglycaemia - as a result of intensive insulin therapy - must be reckoned with [4]
It appears that high blood glucose levels and high glucose variability is associated with increased morbidity and mortality [5]. In this situation ‘low dose’ hydrocortisone (200 to 300 mg/day), which is recommended as an adjunctive therapy in septic shock, may further aggravate problems with glucose control
Summary
In this issue of Critical Care, Loisa and coworkers [1] present the first randomized controlled trial on the influence of mode of hydrocortisone administration on glycaemic control in patients with septic shock. Clinicians are often faced with widely varying glucose levels in patients with severe sepsis or septic shock. In this situation ‘low dose’ hydrocortisone (200 to 300 mg/day), which is recommended as an adjunctive therapy in septic shock, may further aggravate problems with glucose control.
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