A comparison between continuous intravenous infusion versus intermittent bolus doses of Hydrocortisone for circulatory support in patients with sepsis

Abstract

Abstract Background: One the controversial treatment introduced for sepsis, septic shock, Multiorgan dysfunction, and acute respiratory distress syndrome is corticosteroids, because of its properties as anti inflammatory, circulatory support, and its importance in relative adrenal insufficiency. Now its role extended to reversal of microcirculatory changes during sepsis which is amplified by the kidneys in the form of microalbuminuria. Objective: This study aims to compare the effect of continuous intra-venous infusion of low dose versus intermittent injection of bolus doses of hydrocortisone on supporting the circulation in septic patients with favorable effect on the immune response, with a trial to evaluate the value of free cortisol level as a prognostic marker of severity in patients with sepsis. Design: Randomized prospective study. Setting: Ain Shams University intensive care units. Methods: Total sample calculated was 153 patients. Patients were divided into 3 equal Subgroups (51 patients each). Group A: [hydrocortisone injection group](n =51): These patients received a standard therapy for sepsis plus intravenous injection of hydrocortisone 100 mg every 8 hours for 6 days. After the study period hydrocortisone therapy was tapered off over 3 days Group B: [Hydrocortisone infusion group] (n = 51) : These patients received standard therapy for sepsis plus a loading dose of 50 mg hydrocortisone given over 30 minutes followed by continuous intravenous infusion of hydrocortisone 0.18 mg/kg/day diluted in 50 mL of normal saline for 6 days). After the study period, hydrocortisone therapy was tapered off over 3 days.Group C: [Control group] (n=51): These patients received standard therapy for sepsis not affected by the study design, and it included antibiotics, fluids (crystalloids), enteral nutrition, mechanical ventilation, and surgical treatment when indicated.Measurements: FC, serum C-reactive protein, and SOFA score were recorded every day from the day before the steroid therapy (D0) until the 6 days after (D1, D2, D3, D4, D5, and D6). Main Results: MAP decreased from D0 to D6 in both patient groups; however, values were significantly lower in the hydrocortisone group from D1 through to D6 [p value< 0.001]. Mean serum C-reactive protein also decreased from D0 in both patient groups, with significantly lower values in the hydrocortisone group from D3 through to D6 [p value< 0.001]. Mean SOFA score showed significant decrease in the hydrocortisone group but showed no change in the control one and it appeared overtly on D5 and D6 [p value< 0.001] .Conclusions: Low-dose hydrocortisone seems to reduce MAP, serum lactate , SOFA score in patients with early sepsis.