[The impacts of low-dose corticosteroids infusion given in different manners on refractory septic shock patients]

To discuss the influence of different ways of low-dose corticosteroids infusion on hemodynamics, changes in blood glucose level and prognosis in patients with refractory septic shock.

A prospective single-blind randomized controlled trial was conducted. Refractory septic shock patients admitted to the Department of Critical Care Medicine of Jiangxi Provincial People's Hospital from April 1st, 2013 to October 31st, 2014 were enrolled for the study. The patients were divided into control group and research group by random number table. Besides conventional treatment for septic shock, patients in control group were given 200 mg/d hydrocortisone intravenous infusion lasting for 2 hours, while those of research group were given 8.33 mg/h hydrocortisone per hour with an intravenous pump. Treatment lasted for 5 continuous days for both groups. The changes in heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP) and arterial blood lactic acid in both groups were observed at the time of enroldment and 6 hours, 24 hours, 48 hours, and 5 days after the treatment. With a dynamic blood glucose monitor, mean blood glucose (MBG) level, largest amplitude of glycemic excursions (LAGE), glucose variability (GV), and the ratio of hyperglycaemia time were recorded. The duration of shock, length of intensive care unit (ICU) stay, total length of hospital stay, and 28-day mortality of both groups were recorded.

Seventy-nine septic shock patients were assigned to the treatment, with 41 in control group, and 38 in research group. Compared with control group, 6-hour MAP in research group was obviously lowered [mmHg (1 mmHg=0.133 kPa): 66.31±4.38 vs. 68.58±4.86, t=1.062, P=0.033], but there were no significant differences in HR, MAP, CVP, lactic acid clearance and norepinephrine (NE) utilization rates at other time points between two groups. No significant difference in MBG was found between research group and control group (mmol/L: 8.69±2.14 vs. 9.95±3.87, t=1.771, P=0.080), but LAGE, GV, the ratio of hyperglycemia time in research group were significantly lower than those of the control group [LAGE (mmol/L): 17.18±8.97 vs. 22.71±11.80, t=2.331, P=0.022; GV (mmol/L): 2.57±1.05 vs. 3.16±1.37, t=2.136, P=0.036; the ratio of hyperglycemia time: (43.1±11.7)% vs. (49.4±15.3)%, t=2.044, P=0.044]. There was no statistical difference in the following features between research group and control group, such as the duration of shock (days: 3.47±0.98 vs. 3.61±1.07, t=0.605, P=0.547), length of ICU stay (days: 8.74±3.12 vs. 9.97±3.37, t=1.543, P=0.120), total length of hospital stay (days: 18.34±9.27 vs. 19.58±9.83, t=0.576, P=0.566) and 28-day mortality rate (23.68% vs. 26.83%, χ2=0.103, P=0.748).

Compared with slow intravenous infusion, a continuous intravenous supplementation of small amount of hydrocortisone to patients with refractory septic shock could stabilize blood glucose levels and maintain metabolic balance efficiently. However, in both groups there was no significant difference in the efficiency in stabilizing hemodynamics, shortening shock duration, reducing ICU or hospital days and decreasing 28-day mortality.