Diagnosis and Management of Critical Illness-Related Corticosteroid Insufficiency (CIRCI) in Critically Ill Patients (Part I)

Publication Date: November 1, 2017
Last Updated: March 14, 2022

RECOMMENDATIONS

DIAGNOSIS OF CIRCI

The task force makes no recommendation regarding whether to use delta cortisol (change in baseline cortisol at 60 min of <9 μg/dL) after cosyntropin (250 μg) administration or a random plasma cortisol of <10 μg/dL for the diagnosis of CIRCI. (, )
607
We suggest against using plasma free cortisol level rather than plasma total cortisol for the diagnosis of CIRCI. ( Conditional , Very Low )
607
We suggest against using salivary rather than serum cortisol for diagnosing CIRCI. ( Conditional , Very Low )
607
We suggest that the high-dose (250-μg) rather than the low-dose (1-μg) ACTH stimulation test be used for the diagnosis of CIRCI. ( Conditional , Low )
607
We suggest the use of the 250-μg ACTH stimulation test rather than the hemodynamic response to hydrocortisone (50–300 mg) for the diagnosis of CIRCI. ( Conditional , Very Low )
607
We suggest against using corticotropin levels for the routine diagnosis of CIRCI. ( Conditional , Low )
607

CORTICOSTEROID USE IN CRITAL CARE CONDITIONS

Sepsis

We suggest against corticosteroid administration in adult patients with sepsis without shock. ( Conditional , Moderate )
607
We suggest using corticosteroids in patients with septic shock that is not responsive to fluid and moderate- to high-dose vasopressor therapy. ( Conditional , Low )
607
If using corticosteroids for septic shock, we suggest using long course and low dose (e.g., IV hydrocortisone <400 mg/day for at ≥3 days at full dose) rather than high dose and short course in adult patients with septic shock. ( Conditional , Low )
607

Acute Respiratory Distress Syndrome

We suggest use of corticosteroids in patients with early moderate to severe acute respiratory distress syndrome (PaO2/FiO2 of <200 and within 14 days of onset). ( Conditional , Moderate )
607

Major Trauma

We suggest against the use of corticosteroids in major trauma. ( Conditional , Low )
607

Recommendation Grading

Overview

Title

Diagnosis and Management of Critical Illness-Related Corticosteroid Insufficiency (CIRCI) in Critically Ill Patients (Part I)

Authoring Organizations

European Society of Intensive Care Medicine

Society of Critical Care Medicine

Publication Month/Year

November 1, 2017

Last Updated Month/Year

June 6, 2023

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

To update the 2008 consensus statements for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in adult and pediatric patients.

Target Patient Population

Patients with critical illness-related corticosteroid insufficiency

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Hospital

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D003422 - Critical Care, D016638 - Critical Illness, D007362 - Intensive Care Units, D013256 - Steroids, D008901 - Mineralocorticoids

Keywords

critical care, critical illness, corticosteroids insufficiency

Source Citation

Critical Care Medicine: December 2017 - Volume 45 - Issue 12 - p 2078-2088
doi: 10.1097/CCM.0000000000002737