ESPEYB15 8 Adrenals Important for Clinical Practice (5 abstracts)
8.10 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 D , Pastores SM , Rochwerg B , Arlt W , Balk RA , Beishuizen A , Briegel J , Carcillo J , Christ-Crain M , Cooper MS , Marik PE , Umberto Meduri G , Olsen KM , Rodgers SC , Russell JA & Van den Berghe G
General ICU Department, Raymond Poincaré Hospital (APHP), Health Science
To read the full abstract: Crit Care Med. 2017; 45(12): 2078-2088
This guideline replaces/updates the 2008 recommendations regarding the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in adult and pediatric patients. In CIRCI, inadequate glucocorticoid-mediated anti-inflammatory activity is observed in relation to the severity of the critical illness due to somehow disrupted HPA axis, cortisol and receptor to signalling transduction; but the exact mechanism is only poorly understood. The recommendation was achieved by a multispecialty team of 16 international specialists (including endocrinologists and a paediatrician) reviewing the literature and grading its relevance according to established standards (GRADE method). It recommends two possible lab tests for diagnosing CIRCI, e.g. either a random plasma cortisol of < 10 μg/dL (276 nmol/L) or a 60 min-cortisol response to high-dose (250 μg) of ACTH of < 9 μg/dL (248 nmol/L). Experts recommend against the use of corticosteroids in sepsis without shock and suggest its use only in patients with septic shock that does not respond to fluid and vasopressor therapy. In addition, the use of corticosteroids is recommended for hospitalized adult patients with moderate to severe acute respiratory distress syndrome, but not in patients with major trauma/non-septic inflammatory response syndrome. Of note, this guideline was published before the results of the two most-comprehensive studies so far reported on mortality outcomes of hydrocortisone (HC) treatment in septic shock patients (14, 15). However, as discussed below (8.12), even these studies were not able to give a clear answer about the possible benefit or harm of HC. Therefore, the current guidelines may still remain valid.
14. Venkatesh B, Finfer S, Cohen J, Rajbhandari D, Arabi Y, Bellomo R, Billot L, Correa M, Glass P, Harward M, Joyce C, Li Q, McArthur C, Perner A, Rhodes A, Thompson K, Webb S, Myburgh J. Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. N Engl J Med 2018; 378:797-808.
15. Annane D, Renault A, Brun-Buisson C, Megarbane B, Quenot JP, Siami S, Cariou A, Forceville X, Schwebel C, Martin C, Timsit JF, Misset B, Ali Benali M, Colin G, Souweine B, Asehnoune K, Mercier E, Chimot L, Charpentier C, Francois B, Boulain T, Petitpas F, Constantin JM, Dhonneur G, Baudin F, Combes A, Bohe J, Loriferne JF, Amathieu R, Cook F, Slama M, Leroy O, Capellier G, Dargent A, Hissem T, Maxime V, Bellissant E. Hydrocortisone plus Fludrocortisone for Adults with Septic Shock. N Engl J Med 2018; 378:809-818.
Volume 15
Article tools
My recent searches
My recently viewed abstracts
Authors
ESPE Yearbook of Paediatric Endocrinology
ISSN 1662-4009 (Online)
© Bioscientifica 2024 |
Privacy policy |
Cookie settings
BiosciAbstracts
Bioscientifica Abstracts is the gateway to a series of products that provide a permanent, citable record of abstracts for biomedical and life science conferences.
Find out more