Critical illness-related corticosteroid insufficiency guidelines explained

SAN ANTONIO – When corticosteroids are used for septic shock, the dose should be low to moderate, the timing should be early, and the duration should be at least 3 days, said a speaker at the Critical Care Congress sponsored by the Society for Critical Care.

Dosing, timing, and duration are “three critical questions” critical care specialists face that are answered by the new critical illness–related corticosteroid insufficiency (CIRCI) guidelines, continued Stephen M. Pastores, MD, a cochair of the task force that developed guidelines for the diagnosis and management of CIRCI in critically ill patients.

Andrew D. Bowser/Frontline Medical News

The recently published guidelines come in two parts. The first takes into account the most current evidence on the use of corticosteroids in disorders that most clinicians associate with CIRCI, including sepsis/septic shock, acute respiratory distress syndrome, and major trauma (Crit Care Med. 2017 Dec;45[12]:2078-88). Part two of the guidelines, published separately, covers other syndromes, such as influenza, meningitis, burns, and other conditions that at least 80% of the task force members agreed were associated with CIRCI (Crit Care Med. 2018 Jan;46[1]:146-148).

During his presentation, Dr. Pastores limited his remarks to discussion of sepsis and septic shock with corticosteroids. He cautioned that, despite careful deliberations by the panel, the level of evidence behind some of the recommendations was “low to moderate and never high” and that not all task force members agreed with all recommendations.