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, R.A.; Beishuizen, Albertus; Briegel, Josef; Carcillo, Joseph A.; Christ‐Crain, Mirjam; Cooper, Mark S.; Marik, Paul E.; Meduri, G. Umberto; Olsen, Keith M.; Rodgers, Sophia C.; Russell, James A.; Berghe, Greet Van den

doi:10.1007/s00134-017-4919-5

Cited by 252 publications

(224 citation statements)

References 64 publications

(72 reference statements)

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“…A continuous infusion may be associated with less glucose variability but lead to greater suppression of the HPA axis following the withdrawal of corticosteroids . Recent evidence‐based CIRCI guidelines suggest a regimen of hydrocortisone 400 mg/day or less for at least 3 days, but they do not mention an administration technique . In a subgroup analysis from a recent meta‐analysis, steroid administration technique did not influence survival …”

Section: Corticosteroidsmentioning

confidence: 99%

“…63 Evidence-based guidelines suggest using lowdose corticosteroids (IV hydrocortisone less than 400 mg/day) for at least 3 days at full dose in patients with septic shock who are unresponsive to fluids and require moderate-to high-dose vasopressors (i.e., more than 0.1 lg/kg/min of NE dose equivalent). 62 Although the use of fludrocortisone is not discerned in these guidelines, for patients with a high risk for death or for those with an inadequate response to hydrocortisone monotherapy, the addition of fludrocortisone 50 lg/day seems reasonable. 12,48 Midodrine…”

Section: Clinical Application and Role In Therapymentioning

confidence: 99%

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Catecholamine Vasopressor Support Sparing Strategies in Vasodilatory Shock

et al. 2019

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Shock syndromes are associated with unacceptably high rates of mortality in critically ill patients despite advances in therapeutic options. Vasodilatory shock is the most common type encountered in the intensive care unit. It is manifested by cardiovascular failure, peripheral vasodilatation, and arterial hypotension leading to tissue hypoperfusion and organ failure. Hemodynamic support is typically initiated with fluid resuscitation strategies and administration of adrenergic vasopressor agents in nonresponsive patients to restore arterial pressure with subsequent adequate organ reperfusion. Unfortunately, high catecholamine dosing requirements may be necessary to achieve targeted hemodynamic goals that may increase the risk of vasopressor‐induced adverse events. The purpose of this article is to review the clinical efficacy and safety data and potential role in therapy for catecholamine‐sparing agents in vasodilatory shock. Adjunctive therapeutic options to reduce vasoactive support requirements without compromising arterial pressure include arginine vasopressin and analogs, corticosteroids, midodrine, methylene blue, and angiotensin II. Although concomitant vasopressin and corticosteroids have a more defined role in evidence‐based guidelines for managing shock, clinicians may consider other potential catecholamine‐sparing agents.

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Section: Corticosteroidsmentioning

confidence: 99%

Section: Clinical Application and Role In Therapymentioning

confidence: 99%

Catecholamine Vasopressor Support Sparing Strategies in Vasodilatory Shock

et al. 2019

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“…Overall, the question of whether or not to use corticosteroids in patients with septic shock remains unanswered. In clinical practice, corticosteroids are commonly used in patients who are unresponsive to fluid administration and require increasing vasoactive doses, a guideline‐supported practice, albeit with weak recommendations due to low quality of evidence . Regardless, the best supporting data with corticosteroid use in patients with septic shock are for those with early refractory shock, and other uses remain controversial.…”

Section: Noncatecholamine‐derived Vasoactive Agentsmentioning

confidence: 99%

Vasoactive Agent Use in Septic Shock: Beyond First‐Line Recommendations

2019

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Septic shock is a life‐threatening disorder associated with high mortality rates requiring rapid identification and intervention. Vasoactive agents are often required to maintain goal hemodynamics and preserve tissue perfusion. However, guidance regarding the proper administration of adjunct agents for the management of septic shock is limited in patients who are refractory to norepinephrine. This review summarizes vasopressor agents and describes the nuanced application of these agents in patients with septic shock, specifically focusing on clinical scenarios with limited guidance including patients who are nonresponsive to first‐line agents and individuals with mixed shock states, tachyarrhythmias, obesity, valvular abnormalities, or other comorbid conditions.

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“…1 This has led to a proliferation of terms such as relative adrenal insufficient and critical illness-related corticosteroid insufficiency with associated diagnostic criteria based on basal cortisol or the peak or increase in cortisol during an adrenocorticotropic (ACTH) stimulation test. 2 The robustness of these concepts in clinical practice has been questionable as has the applicability of the diagnostic criteria to patients outside of the septic shock population. The recent study by Blum et al 3 makes a major contribution to this field by examining the relationship between HPA axis function and response to glucocorticoid treatment in patients with community-acquired pneumonia.…”

Section: Please See Related Paper On Pages [374-382] Of This Issuementioning

confidence: 99%

“…Various studies, primarily examining patients with septic shock, have emerged from the critical care setting suggesting that abnormalities of the hypothalamo‐pituitary‐adrenal (HPA) axis are common and that patients with these abnormalities might benefit from ‘replacement’ glucocorticoids . This has led to a proliferation of terms such as relative adrenal insufficient and critical illness‐related corticosteroid insufficiency with associated diagnostic criteria based on basal cortisol or the peak or increase in cortisol during an adrenocorticotropic (ACTH) stimulation test . The robustness of these concepts in clinical practice has been questionable as has the applicability of the diagnostic criteria to patients outside of the septic shock population.…”

mentioning

confidence: 99%