RT Book, Section
A1 Marik, Paul E.
A2 Hall, Jesse B.
A2 Schmidt, Gregory A.
A2 Kress, John P.
SR Print(0)
ID 1107711431
T1 Critical Illness–Related Corticosteroid Insufficiency
T2 Principles of Critical Care, 4e
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 9780071738811
LK accessmedicine.mhmedical.com/content.aspx?aid=1107711431
RD 2024/04/18
AB Acute  adrenal  insufficiency  in  critically  ill  patients  is  best  referred  to  as  critical  illness–related  corticosteroid  insufficiency  (CIRCI).CIRCI  may  arise  due  to  adrenal  insufficiency  or  tissue  resistance  to  cortisol.Adrenal  insufficiency  is  best  diagnosed  by  a  random  cortisol  <10µg/dL  (Type  1  CIRCI)  or  a  delta  of  <9µg/dL  after  a  250µg  cosyntropin  stimulation  test  (Type  II  CIRCI).The  diagnosis  of  adrenal  insufficiency/CIRCI  should  not  be  made  on  the  basis  of  laboratory  criteria  alone.Treatment  with  low-dose  hydrocortisone  (200  mg/day)  or  methylprednisolone  (60  mg/day)  should  be  considered  in  patients  with  septic  shock  who  have  responded  “poorly”  to  resuscitation  with  fluids  and  vasopressor  agents  and  those  with  ARDS  who  have  failed  to  show  an  improvement  within  48  hours  of  supportive  care.  The  role  of  low-dose  hydrocortisone  in  patients  with  severe  sepsis  and  other  clinical  situations  in  the  ICU  remains  to  be  determined.