Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Feb 4, 2017; 6(1): 65-73
Published online Feb 4, 2017. doi: 10.5492/wjccm.v6.i1.65
Timing, method and discontinuation of hydrocortisone administration for septic shock patients
Miguel A Ibarra-Estrada, Quetzalcóatl Chávez-Peña, Claudia I Reynoso-Estrella, Jorge Rios-Zermeño, Pável E Aguilera-González, Miguel A García-Soto, Guadalupe Aguirre-Avalos
Miguel A Ibarra-Estrada, Pável E Aguilera-González, Critical Care Unit, Instituto Jalisciense de Cancerología, Guadalajara Jalisco 44280, Mexico
Miguel A Ibarra-Estrada, Pável E Aguilera-González, Critical Care Unit, Hospital General Regional #180, Instituto Mexicano del Seguro Social, Tlajomulco de Zúñiga Jalisco 45655, Mexico
Quetzalcóatl Chávez-Peña, Miguel A García-Soto, Transplant Care Unit, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara Jalisco 44340, Mexico
Quetzalcóatl Chávez-Peña, Guadalupe Aguirre-Avalos, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara Jalisco 44340, Mexico
Claudia I Reynoso-Estrella, Jorge Rios-Zermeño, Guadalupe Aguirre-Avalos, Critical Care Unit, Hospital Civil Fray Antonio Alcalde, Guadalajara Jalisco 44280, Mexico
Author contributions: Ibarra-Estrada MA designed the study, performed data collection, statistical analysis, interpretation of data, and drafted the manuscript; Chávez-Peña Q and Reynoso-Estrella CI performed data collection and helped draft the manuscript; Rios-Zermeño J, Aguilera-González PE, García-Soto MA and Aguirre-Avalos G performed data collection; all authors were involved and approved the final manuscript.
Institutional review board statement: This study has been approved by the scientific and ethics committees at Instituto Jalisciense de Cancerología (INV-01/16), and Hospital Civil Fray Antonio Alcalde (HCG/CEI-0321/16). A copy of approval can be provided on request.
Informed consent statement: All study participants, or their next of kin, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: None of the authors have commercial associations or financial involvements that might pose a conflict of interest related to the content of this article.
Data sharing statement: Data presented in the manuscript is anonymized, and the risk of identifying individual patients is very low. No additional data is available from the study other than the data stated in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Miguel A Ibarra-Estrada, Critical Care Unit, Instituto Jalisciense de Cancerología, Coronel Calderón 715, Guadalajara Jalisco 44280, Mexico. drmiguelibarra@hotmail.com
Telephone: +52-33-40401508
Received: August 24, 2016
Peer-review started: August 25, 2016
First decision: October 20, 2016
Revised: November 6, 2016
Accepted: January 11, 2017
Article in press: January 14, 2017
Published online: February 4, 2017
Processing time: 151 Days and 4.4 Hours
Core Tip

Core tip: Until now, the indications, timing, administration, and discontinuation of hydrocortisone for septic shock patients have been widely variable. Our study found that continuous infusion was the most effective method compared to bolus administration; we also identified a time from vasopressor administration of ≤ 13 h and/or a norepinephrine dose of ≤ 0.28 μg/kg per minute as the best clinical criteria for initiation of hydrocortisone. We found no benefit from the tapering strategy, which was only associated with a higher incidence of hyperglycemia and hypokalemia.