Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: Consensus statements from an international task force by the American College of Critical Care Medicine

@article{Marik2008RecommendationsFT,
  title={Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: Consensus statements from an international task force by the American College of Critical Care Medicine},
  author={Paul Ellis Marik and Stephen M Pastores and Djillali Annane and Gianfranco Umberto Meduri and Charles L Sprung and Wiebke Arlt and Didier Keh and Josef Briegel and Albertus Beishuizen and Ioanna Dimopoulou and Stylianos Tsagarakis and Mervyn Singer and George P. Chrousos and Gary P. Zaloga and Faran Bokhari and Michael Vogeser},
  journal={Critical Care Medicine},
  year={2008},
  volume={36},
  pages={1937-1949}
}
OBJECTIVE To develop consensus statements for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients. [] Key MethodPARTICIPANTS A multidisciplinary, multispecialty task force of experts in critical care medicine was convened from the membership of the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. In addition, international experts in endocrinology were invited to participate.
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
TLDR
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.
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
TLDR
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.
Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part II): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017
Objective: To update the 2008 consensus statements for the diagnosis and management of critical illness‐related corticosteroid insufficiency (CIRCI) in adult and pediatric patients. *Correspondence:
Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline.
TLDR
A low diagnostic threshold in acutely ill patients, as well as in patients with predisposing factors, is suggested for pregnant women with unexplained persistent nausea, fatigue, and hypotension and a short corticotropin test is recommended as the "gold standard" diagnostic tool to establish the diagnosis.
Critical Illness-Related Corticosteroid Insufficiency (CIRCI): A Narrative Review from a Multispecialty Task Force of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM)
TLDR
Novel insights into the pathophysiology of CIRCI add to the limitations of the current diagnostic tools to identify at-risk patients and may also impact how corticosteroids are used in patients with CirCI.
Critical illness-related corticosteroid insufficiency (CIRCI): a narrative review from a Multispecialty Task Force of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM)
TLDR
Novel insights into the pathophysiology of CIRCI add to the limitations of the current diagnostic tools to identify at-risk patients and may also impact how corticosteroids are used in patients with CirCI.
The Development of a Protocol for Critical Illness-Related Corticosteroid Insufficiency (CIRCI) at a Tertiary Hospital
TLDR
The presence of refractory shock unresponsive to fluid resuscitation and vasopressors should warrant the clinical suspicion for the existence of CIRCI and should trigger a cascade of management strategies.
[Corticosteroid insufficiency in the critically ill. Pathomechanisms and recommendations for diagnosis and treatment].
TLDR
Recommendations for diagnosis and treatment of critical illness-related corticosteroid insufficiency focusing on patients with septic shock and acute respiratory distress syndrome and preliminary data suggest that patients with vasodilatory shock after cardiac surgery and patients with liver cirrhosis and sepsis can benefit from Corticosteroids.
The role of corticosteroids in severe community-acquired pneumonia: a systematic review
TLDR
According to the GRADE system, available studies do not support the recommendation of corticosteroids as a standard of care for patients with severe CAP, but it may be reasonable to conclude that Corticosteroid administration is safe in patients withsevere infections receiving antimicrobial therapy.
...
...

References

SHOWING 1-10 OF 159 REFERENCES
Use of corticosteroid therapy in patients with sepsis and septic shock: An evidence-based review
TLDR
Low doses of corticosteroids are recommended in patients with septic shock and high- doses are not recommended in severe sepsis, with A being the highest grade.
Grading strength of recommendations and quality of evidence in clinical guidelines: report from an american college of chest physicians task force.
TLDR
An American College of Chest Physicians task force formulated the criteria for a grading system to be utilized in all ACCP guidelines that included simplicity and transparency, explicitness of methodology, and consistency with current methodological approaches to the grading process.
Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. 1992.
An American College ofChest Physicians/Society ofCritical Care Medicine Consensus Conference was held in Northbrook in August 1991 with the goal of agreeing on a set of de6nitions that could be
Steroids for early acute respiratory distress syndrome: Critical appraisal of Meduri GU, Golden E, Freire AX, et al: Methylprednisolone infusion in early severe ARDS: Results of a randomized controlled trial. Chest 2007; 131:954–963
  • J. Foster
  • Medicine
    Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
  • 2010
TLDR
The protocol suggested by Meduri and colleagues presents an attractive therapeutic adjunct, but steroids in early acute respiratory distress syndrome cannot be recommended as standard therapy at this time.
Report of the American-European consensus conference on ARDS: Definitions, mechanisms, relevant outcomes and clinical trial coordination
TLDR
It was felt that international coordination between North America and Europe in clinical studies of ARDS was becoming increasingly important in order to address the recent plethora of potential therapeutic agents for the prevention and treatment of AR DS.
Adrenal hemorrhage: a 25-year experience at the Mayo Clinic.
TLDR
A high index of suspicion is required to make a timely diagnosis of AH, a heterogeneous entity that occurs in the postoperative period, in the antiphospholipid-antibody syndrome, in heparin-associated thrombocytopenia, or in the setting of severe physical stress and multiorgan failure.
Effect of low doses of corticosteroids in septic shock patients with or without early acute respiratory distress syndrome*
TLDR
This post hoc analysis shows that a 7-day treatment with low doses of corticosteroids was associated with better outcomes in septic shock-associated early ARDS nonresponders, but not in responders and not inseptic shock patients without ARDS.
Corticosteroids for severe sepsis and septic shock: a systematic review and meta-analysis
TLDR
For all trials, regardless of duration of treatment and dose, use of corticosteroids did not significantly affect mortality, however, mortality at 28 days and hospital morality was reduced with long courses of low doses of cortiosteroids.
The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination.
The acute respiratory distress syndrome (ARDS), a process of nonhydrostatic pulmonary edema and hypoxemia associated with a variety of etiologies, carries a high morbidity, mortality (10 to 90%), and
Steroid treatment in ARDS: a critical appraisal of the ARDS network trial and the recent literature
TLDR
Prolonged glucocorticoid treatment substantially and significantly improves meaningful patient-centered outcome variables, and has a distinct survival benefit when initiated before day 14 of ARDS.
...
...