[Intensive Care Med指南]:SCCM/ESICM危重病相关肾上腺皮质功能不全(CIRCI)诊断与治疗指南(Part I) | 中国病理生理学会危重病医学专业委员会
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[Intensive Care Med指南]:SCCM/ESICM危重病相关肾上腺皮质功能不全(CIRCI)诊断与治疗指南(Part I)
2017年10月23日 指南导读, 进展交流 暂无评论

CONFERENCE REPORTS AND EXPERT PANEL

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

Djillali Annane, Stephen M. Pastores, Bram Rochwerg, et al

Intensive Care Medicine 2017 (in press)

DOI 10.1007/s00134-017-4919-5

Recommendations for diagnosis of CIRCI

1. Is total cortisol response to synthetic adrenocorticotropic hormone (ACTH; cosyntropin) superior to random plasma or serum total cortisol for the diagnosis of CIRCI?

Recommendation: The task force makes no recommendation regarding whether to use delta cortisol (change in baseline cortisol at 60 min of <9 μg/dl) after cosyntropin (250 μg) administration or a random plasma cortisol of <10 μg/dl for the diagnosis of CIRCI.

2. Is plasma or serum free cortisol level superior to plasma total cortisol level for the diagnosis of CIRCI?

Recommendation: We suggest against using plasma free cortisol level rather than plasma total cortisol for the diagnosis of CIRCI (conditional recommendation, very low quality of evidence).

3. Is salivary free cortisol level superior to plasma total cortisol level for the diagnosis of CIRCI?

Recommendation: We suggest against using salivary rather than serum cortisol for diagnosing CIRCI (conditional recommendation, very low quality of evidence).

4. Is the 1-μg ACTH stimulation test superior to the 250-μg ACTH test for the diagnosis of CIRCI?

Recommendation: We suggest that the high-dose (250-μg) rather than the low-dose (1-μg) ACTH stimulation test be used for the diagnosis of CIRCI (conditional recommendation, low quality of evidence).

5. Is hemodynamic response to hydrocortisone (50–300 mg) superior to the 250-μg ACTH stimulation test for the diagnosis of CIRCI?

Recommendation: We suggest the use of the 250-μg ACTH stimulation test rather than the hemodynamic response to hydrocortisone (50–300 mg) for the diagnosis of CIRCI (conditional recommendation, very low quality of evidence).

6. Is corticotropin level superior to the 250-μg ACTH stimulation test for the diagnosis of CIRCI?

Recommendation: We suggest against using corticotropin levels for the routine diagnosis of CIRCI (conditional recommendation, low quality of evidence).

Recommendations for corticosteroid use in critical care conditions

Sepsis

A. Should corticosteroids be administered among hospitalized adult patients with sepsis without shock?

Recommendation: We suggest against corticosteroid administration in adult patients with sepsis without shock (conditional recommendation, moderate quality of evidence).

B. Should corticosteroids be administered among hospitalized adult patients with septic shock?

Recommendation: We suggest using corticosteroids in patients with septic shock that is not responsive to fluid and moderate- to high-dose vasopressor therapy (conditional recommendation, low quality of evidence).

C. What is the recommended dose and duration of treatment among hospitalized adult patients with septic shock treated with corticosteroids?

Recommendation: If using corticosteroids for septic shock, we suggest using long course and low dose (e.g., IV hydrocortisone <400 mg/day for at ≥3 days at full dose) rather than high dose and short course in adult patients with septic shock (conditional recommendation, low quality of evidence).

Acute respiratory distress syndrome

Should corticosteroids be administered among hospitalized adult patients with acute respiratory distress syndrome?

Recommendation: We suggest use of corticosteroids in patients with early moderate to severe acute respiratory distress syndrome (PaO2/FiO2 of < 200 and within 14 days of onset) (conditional recommendation, moderate quality of evidence).

Major trauma

Should corticosteroids be administered among hospitalized adult patients with major trauma?

Recommendation: We suggest against the use of corticosteroids in major trauma (conditional recommendation, low quality of evidence).

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