Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I)

Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017

Djillali Annane, Stephen M. Pastores, Bram Rochwerg, Wiebke Arlt, Robert A. Balk, Albertus Beishuizen, Josef Briegel, Joseph Carcillo, Mirjam Christ-Crain, Mark S. Cooper, Paul E. Marik, Gianfranco Meduri, Keith M. Olsen, Sophia Rodgers, James A. Russell, Greet Van den Berghe

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Objective: To update the 2008 consensus statements for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in adult and pediatric patients. Participants: A multispecialty task force of 16 international experts in Critical Care Medicine, endocrinology, and guideline methods, all of them members of the Society of Critical Care Medicine and/or the European Society of Intensive Care Medicine. Design/methods: The recommendations were based on the summarized evidence from the 2008 document in addition to more recent findings from an updated systematic review of relevant studies from 2008 to 2017 and were formulated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The strength of each recommendation was classified as strong or conditional, and the quality of evidence was rated from high to very low based on factors including the individual study design, the risk of bias, the consistency of the results, and the directness and precision of the evidence. Recommendation approval required the agreement of at least 80% of the task force members. Results: The task force was unable to reach agreement on a single test that can reliably diagnose CIRCI, although delta cortisol (change in baseline cortisol at 60 min of <9 µg/dl) after cosyntropin (250 µg) administration and a random plasma cortisol of <10 µg/dl may be used by clinicians. We suggest against using plasma free cortisol or salivary cortisol level over plasma total cortisol (conditional, very low quality of evidence). For treatment of specific conditions, we suggest using intravenous (IV) hydrocortisone <400 mg/day for ≥3 days at full dose in patients with septic shock that is not responsive to fluid and moderate- to high-dose vasopressor therapy (conditional, low quality of evidence). We suggest not using corticosteroids in adult patients with sepsis without shock (conditional recommendation, moderate quality of evidence). We suggest the use of IV methylprednisolone 1 mg/kg/day in patients with early moderate to severe acute respiratory distress syndrome (PaO2/FiO2 < 200 and within 14 days of onset) (conditional, moderate quality of evidence). Corticosteroids are not suggested for patients with major trauma (conditional, low quality of evidence). Conclusions: Evidence-based recommendations for the use of corticosteroids in critically ill patients with sepsis and septic shock, acute respiratory distress syndrome, and major trauma have been developed by a multispecialty task force.

Original languageEnglish (US)
Pages (from-to)1751-1763
Number of pages13
JournalIntensive care medicine
Volume43
Issue number12
DOIs
StatePublished - Dec 1 2017

Fingerprint

Critical Illness
Hydrocortisone
Adrenal Cortex Hormones
Guidelines
Advisory Committees
Adult Respiratory Distress Syndrome
Septic Shock
Sepsis
Cosyntropin
Severe Acute Respiratory Syndrome
Endocrinology
Methylprednisolone
Wounds and Injuries
Critical Care
Shock
Medicine
Pediatrics
Therapeutics

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I) : Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. / Annane, Djillali; Pastores, Stephen M.; Rochwerg, Bram; Arlt, Wiebke; Balk, Robert A.; Beishuizen, Albertus; Briegel, Josef; Carcillo, Joseph; Christ-Crain, Mirjam; Cooper, Mark S.; Marik, Paul E.; Meduri, Gianfranco; Olsen, Keith M.; Rodgers, Sophia; Russell, James A.; Van den Berghe, Greet.

In: Intensive care medicine, Vol. 43, No. 12, 01.12.2017, p. 1751-1763.

Research output: Contribution to journalArticle

Annane, D, Pastores, SM, Rochwerg, B, Arlt, W, Balk, RA, Beishuizen, A, Briegel, J, Carcillo, J, Christ-Crain, M, Cooper, MS, Marik, PE, Meduri, G, Olsen, KM, Rodgers, S, Russell, JA & Van den Berghe, G 2017, 'Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017', Intensive care medicine, vol. 43, no. 12, pp. 1751-1763. https://doi.org/10.1007/s00134-017-4919-5
Annane, Djillali ; Pastores, Stephen M. ; Rochwerg, Bram ; Arlt, Wiebke ; Balk, Robert A. ; Beishuizen, Albertus ; Briegel, Josef ; Carcillo, Joseph ; Christ-Crain, Mirjam ; Cooper, Mark S. ; Marik, Paul E. ; Meduri, Gianfranco ; Olsen, Keith M. ; Rodgers, Sophia ; Russell, James A. ; Van den Berghe, Greet. / Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I) : Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. In: Intensive care medicine. 2017 ; Vol. 43, No. 12. pp. 1751-1763.
@article{3d6b885c674540b6829a4b416f4990e1,
title = "Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017",
abstract = "Objective: To update the 2008 consensus statements for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in adult and pediatric patients. Participants: A multispecialty task force of 16 international experts in Critical Care Medicine, endocrinology, and guideline methods, all of them members of the Society of Critical Care Medicine and/or the European Society of Intensive Care Medicine. Design/methods: The recommendations were based on the summarized evidence from the 2008 document in addition to more recent findings from an updated systematic review of relevant studies from 2008 to 2017 and were formulated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The strength of each recommendation was classified as strong or conditional, and the quality of evidence was rated from high to very low based on factors including the individual study design, the risk of bias, the consistency of the results, and the directness and precision of the evidence. Recommendation approval required the agreement of at least 80{\%} of the task force members. Results: The task force was unable to reach agreement on a single test that can reliably diagnose CIRCI, although delta cortisol (change in baseline cortisol at 60 min of <9 µg/dl) after cosyntropin (250 µg) administration and a random plasma cortisol of <10 µg/dl may be used by clinicians. We suggest against using plasma free cortisol or salivary cortisol level over plasma total cortisol (conditional, very low quality of evidence). For treatment of specific conditions, we suggest using intravenous (IV) hydrocortisone <400 mg/day for ≥3 days at full dose in patients with septic shock that is not responsive to fluid and moderate- to high-dose vasopressor therapy (conditional, low quality of evidence). We suggest not using corticosteroids in adult patients with sepsis without shock (conditional recommendation, moderate quality of evidence). We suggest the use of IV methylprednisolone 1 mg/kg/day in patients with early moderate to severe acute respiratory distress syndrome (PaO2/FiO2 < 200 and within 14 days of onset) (conditional, moderate quality of evidence). Corticosteroids are not suggested for patients with major trauma (conditional, low quality of evidence). Conclusions: Evidence-based recommendations for the use of corticosteroids in critically ill patients with sepsis and septic shock, acute respiratory distress syndrome, and major trauma have been developed by a multispecialty task force.",
author = "Djillali Annane and Pastores, {Stephen M.} and Bram Rochwerg and Wiebke Arlt and Balk, {Robert A.} and Albertus Beishuizen and Josef Briegel and Joseph Carcillo and Mirjam Christ-Crain and Cooper, {Mark S.} and Marik, {Paul E.} and Gianfranco Meduri and Olsen, {Keith M.} and Sophia Rodgers and Russell, {James A.} and {Van den Berghe}, Greet",
year = "2017",
month = "12",
day = "1",
doi = "10.1007/s00134-017-4919-5",
language = "English (US)",
volume = "43",
pages = "1751--1763",
journal = "Intensive Care Medicine",
issn = "0342-4642",
publisher = "Springer Verlag",
number = "12",

}

TY - JOUR

T1 - Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I)

T2 - Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017

AU - Annane, Djillali

AU - Pastores, Stephen M.

AU - Rochwerg, Bram

AU - Arlt, Wiebke

AU - Balk, Robert A.

AU - Beishuizen, Albertus

AU - Briegel, Josef

AU - Carcillo, Joseph

AU - Christ-Crain, Mirjam

AU - Cooper, Mark S.

AU - Marik, Paul E.

AU - Meduri, Gianfranco

AU - Olsen, Keith M.

AU - Rodgers, Sophia

AU - Russell, James A.

AU - Van den Berghe, Greet

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Objective: To update the 2008 consensus statements for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in adult and pediatric patients. Participants: A multispecialty task force of 16 international experts in Critical Care Medicine, endocrinology, and guideline methods, all of them members of the Society of Critical Care Medicine and/or the European Society of Intensive Care Medicine. Design/methods: The recommendations were based on the summarized evidence from the 2008 document in addition to more recent findings from an updated systematic review of relevant studies from 2008 to 2017 and were formulated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The strength of each recommendation was classified as strong or conditional, and the quality of evidence was rated from high to very low based on factors including the individual study design, the risk of bias, the consistency of the results, and the directness and precision of the evidence. Recommendation approval required the agreement of at least 80% of the task force members. Results: The task force was unable to reach agreement on a single test that can reliably diagnose CIRCI, although delta cortisol (change in baseline cortisol at 60 min of <9 µg/dl) after cosyntropin (250 µg) administration and a random plasma cortisol of <10 µg/dl may be used by clinicians. We suggest against using plasma free cortisol or salivary cortisol level over plasma total cortisol (conditional, very low quality of evidence). For treatment of specific conditions, we suggest using intravenous (IV) hydrocortisone <400 mg/day for ≥3 days at full dose in patients with septic shock that is not responsive to fluid and moderate- to high-dose vasopressor therapy (conditional, low quality of evidence). We suggest not using corticosteroids in adult patients with sepsis without shock (conditional recommendation, moderate quality of evidence). We suggest the use of IV methylprednisolone 1 mg/kg/day in patients with early moderate to severe acute respiratory distress syndrome (PaO2/FiO2 < 200 and within 14 days of onset) (conditional, moderate quality of evidence). Corticosteroids are not suggested for patients with major trauma (conditional, low quality of evidence). Conclusions: Evidence-based recommendations for the use of corticosteroids in critically ill patients with sepsis and septic shock, acute respiratory distress syndrome, and major trauma have been developed by a multispecialty task force.

AB - Objective: To update the 2008 consensus statements for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in adult and pediatric patients. Participants: A multispecialty task force of 16 international experts in Critical Care Medicine, endocrinology, and guideline methods, all of them members of the Society of Critical Care Medicine and/or the European Society of Intensive Care Medicine. Design/methods: The recommendations were based on the summarized evidence from the 2008 document in addition to more recent findings from an updated systematic review of relevant studies from 2008 to 2017 and were formulated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The strength of each recommendation was classified as strong or conditional, and the quality of evidence was rated from high to very low based on factors including the individual study design, the risk of bias, the consistency of the results, and the directness and precision of the evidence. Recommendation approval required the agreement of at least 80% of the task force members. Results: The task force was unable to reach agreement on a single test that can reliably diagnose CIRCI, although delta cortisol (change in baseline cortisol at 60 min of <9 µg/dl) after cosyntropin (250 µg) administration and a random plasma cortisol of <10 µg/dl may be used by clinicians. We suggest against using plasma free cortisol or salivary cortisol level over plasma total cortisol (conditional, very low quality of evidence). For treatment of specific conditions, we suggest using intravenous (IV) hydrocortisone <400 mg/day for ≥3 days at full dose in patients with septic shock that is not responsive to fluid and moderate- to high-dose vasopressor therapy (conditional, low quality of evidence). We suggest not using corticosteroids in adult patients with sepsis without shock (conditional recommendation, moderate quality of evidence). We suggest the use of IV methylprednisolone 1 mg/kg/day in patients with early moderate to severe acute respiratory distress syndrome (PaO2/FiO2 < 200 and within 14 days of onset) (conditional, moderate quality of evidence). Corticosteroids are not suggested for patients with major trauma (conditional, low quality of evidence). Conclusions: Evidence-based recommendations for the use of corticosteroids in critically ill patients with sepsis and septic shock, acute respiratory distress syndrome, and major trauma have been developed by a multispecialty task force.

UR - http://www.scopus.com/inward/record.url?scp=85029760772&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85029760772&partnerID=8YFLogxK

U2 - 10.1007/s00134-017-4919-5

DO - 10.1007/s00134-017-4919-5

M3 - Article

VL - 43

SP - 1751

EP - 1763

JO - Intensive Care Medicine

JF - Intensive Care Medicine

SN - 0342-4642

IS - 12

ER -