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

Marik, Paul E.; Pastores, Stephen M.; Annane, Djillali; Meduri, G. Umberto; Sprung, Charles L.; Arlt, Wiebke; Keh, Didier; Briegel, Josef; Beishuizen, Albertus; Dimopoulou, Ioanna; Tsagarakis, Stylianos; Singer, Mervyn; Chrousos, George P.; Zaloga, Gary P.; Bokhari, Faran; Vogeser, Michael

doi:10.1097/ccm.0b013e31817603ba

Cited by 814 publications

(730 citation statements)

References 129 publications

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“…While several reports recommend continuous infusion at 10 mg/hr after intravenous infusion of 100 mg is given for the management of blood glucose,152 the utility of continuous intravenous infusion of steroids with long half‐lives is not clear. The period of administration is not fixed at 5 days, and administration of steroids for a long time should be avoided.…”

Section: Cq8: Corticosteroid Therapy For Septic Shockmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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Background and PurposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two‐thirds (>66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J‐SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta‐analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese‐specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non‐specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

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Section: Cq8: Corticosteroid Therapy For Septic Shockmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

View full text Add to dashboard Cite

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“…The duration of MV was 11 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) days in the nonetomidate group and 13 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) days in the etomidate group (p = 0.275), and the ICU length of stay was 15 (9-28) days in the non-etomidate group and 16 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) days in the etomidate group (p = 0.422). Four (7.4 %) patients in the non-etomidate group and six (6 %) patients in the etomidate group died (p = 1).…”

Section: Patientsmentioning

confidence: 99%

Etomidate increases susceptibility to pneumonia in trauma patients

Asehnoune

Mahé²,

Séguin

et al. 2012

Intensive Care Med

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“…As a result of decreased cortisol secretion and/or tissue resistance (GR abnormalities) inadequate corticosteroid activity is present in many critically ill patients, particularly those with sepsis. This condition has been termed critical illnessrelated corticosteroid insufficiency (CIRCI) [5,6]. The presence of CIRCI may increase the morbidity and mortality of critically ill patients and predispose to PTSD [6][7][8][9].…”

mentioning

confidence: 99%

“…The diagnosis of CIRCI is fraught with difficulties and at present this diagnosis is best made by a random (stress) cortisol of less than 10 lg/dl or a delta cortisol of less than 9 lg/dl after a 250 lg ACTH stimulation test [5,6,10]. One approach to resolving the question of whether too little glucocorticoid signal ultimately ''gets through'' is to examine target tissues whose function is regulated in part by glucocorticoids.…”

mentioning

confidence: 99%

The “koala stress syndrome” and adrenal responsiveness in the critically ill

Marik

Levitov

2010

Intensive Care Med

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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

Abstract: Evidence-linked consensus statements with regard to the diagnosis and management of corticosteroid deficiency in critically ill patients have been developed by a multidisciplinary, multispecialty task force.

Cited by 814 publications

References 129 publications

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Etomidate increases susceptibility to pneumonia in trauma patients

The “koala stress syndrome” and adrenal responsiveness in the critically ill

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