When to Give Steroids in Critically Ill Adult Patients

Consensus recommendations from the American College of Critical Care Medicine

Adrenal failure is reported with increasing frequency in critically ill patients, but diagnosis and management of this disorder remain controversial. An international task force (members of 2 critical care medicine societies and experts in endocrinology) was convened to develop consensus guidelines on diagnosis and treatment of “critical illness–related corticosteroid insufficiency” (CIRCI). The task force’s major recommendations follow:

Adrenal insufficiency in critically ill patients should be diagnosed either by a change in cortisol level of <9 μg/dL after administration of 250 μg of cosyntropin (delta cortisol test) or by a random total cortisol level of <10 μg/dL.
Use of free cortisol levels cannot be recommended at this time (even thoug…

Reviewing Author

Neil H. Winawer, MD

Disclosures

Nothing to disclose

Neil H. Winawer, MD

Disclosures

Nothing to disclose