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Open Access 01-12-2015 | Research

Associations between bolus infusion of hydrocortisone, glycemic variability and insulin infusion rate variability in critically Ill patients under moderate glycemic control

Authors: Roosmarijn T. M. van Hooijdonk, Jan M. Binnekade, Lieuwe D. J. Bos, Janneke Horn, Nicole P. Juffermans, Ameen Abu-Hanna, Marcus J. Schultz

Published in: Annals of Intensive Care | Issue 1/2015

Abstract

Background

We retrospectively studied associations between bolus infusion of hydrocortisone and variability of the blood glucose level and changes in insulin rates in intensive care unit (ICU) patients.

Methods

‘Glycemic variability’ and ‘insulin infusion rate variability’ were calculated from and expressed as the standard deviation (SD) of all blood glucose levels and insulin infusion rates during stay in the ICU, respectively. Glycemic and insulin infusion rate variability in patients who received bolus infusion of hydrocortisone were compared to those in patients who never received bolus infusion of hydrocortisone. Multivariate analysis was performed to correct for potential covariates including disease severity.

Results

We included 6409 patients over 6 years; of them 962 received bolus infusion of hydrocortisone. Compared to patients who never received bolus infusion of hydrocortisone, patients who received hydrocortisone had their blood glucose level measured more frequently, had higher glycemic variability; were more frequently treated with intravenous insulin and had higher insulin infusion rate variability. The association between hydrocortisone treatment and glycemic variability was independent of disease severity, but the effect of hydrocortisone treatment on blood glucose variability was less strong in the more severely ill patients. The association between hydrocortisone and insulin infusion rate variability was also independent of disease severity, and independent of glycemic variability.

Conclusions

Bolus infusion of hydrocortisone is independently associated with higher glycemic variability and higher insulin infusion rate variability in ICU patients. Studies are needed to see if continuous infusion of hydrocortisone prevents higher glycemic variability and higher insulin infusion rate variability.

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Title: Associations between bolus infusion of hydrocortisone, glycemic variability and insulin infusion rate variability in critically Ill patients under moderate glycemic control
Authors: Roosmarijn T. M. van Hooijdonk
Jan M. Binnekade
Lieuwe D. J. Bos
Janneke Horn
Nicole P. Juffermans
Ameen Abu-Hanna
Marcus J. Schultz
Publication date: 01-12-2015
Publisher: Springer Paris
Published in: Annals of Intensive Care / Issue 1/2015
Electronic ISSN: 2110-5820
DOI: https://doi.org/10.1186/s13613-015-0077-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Associations between bolus infusion of hydrocortisone, glycemic variability and insulin infusion rate variability in critically Ill patients under moderate glycemic control

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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