Critical Illness-Related Corticosteroid Insufficiency (CIRCI) is a transient condition seen in critically-ill patients. This arises from an impairment of the hypothalamic-pituitary axis.
Criteria for diagnosis:
(1) random serum total cortisol < 10 µg/dL
(2) delta serum total cortisol after 250 µg ACTH < 9 µg/dL
Patients who may benefit from glucocorticoids include:
(1) vasopressor-dependent septic shock
(2) early severe ARDS with PaO2/FIO2 ratio < 200
Glucocorticosteroids to consider may include:
(1) hydrocortisone
(2) methylprednisolone
Dexamethasone is not recommended.
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