Key Hospitalist Clinical Practice Guidelines in 2017

John Anello; Brian Feinberg; John Heinegg; Yonah Korngold; Richard Lindsey; Cristina Wojdylo; Olivia Wong, DO


January 16, 2018

In This Article

Corticosteroid Insufficiency in Critical Illness

Society of Critical Care Medicine and European Society of Intensive Care Medicine

The task force was unable to reach agreement on a single test that can reliably diagnose critical illness-related corticosteroid insufficiency (CIRCI), although delta cortisol (change in baseline cortisol at 60 minutes of <9 μg/dL) after cosyntropin (250 μg) administration and a random plasma cortisol of <10 μg/dL may be used by clinicians.

Suggest against using plasma-free cortisol or salivary cortisol level over plasma total cortisol.

For treatment of specific conditions, suggest using 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.

Suggest not using corticosteroids in adult patients with sepsis without shock.

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).


  • Annane D, Pastores SM, Rochwerg B, et al. 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. Crit Care Med. 2017 Sep 21.


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