The Development of a Protocol for Critical Illness-Related Corticosteroid Insufficiency (CIRCI) at a Tertiary Hospital
https://doi.org/10.15605/jafes.037.01.03
- Author:
Anna Elvira Arcellana
1
;
Kenneth Wilson Lim
2
;
Marlon Arcegono
3
;
Cecilia Jimeno
1
Author Information
1. Division of Endocrinology, Diabetes and Metabolism, University of the Philippines Manila, Philippine General Hospital
2. Division of Pulmonary Medicine, University of the Philippines Manila, Philippine General Hospital
3. Division of Infectious Diseases, University of the Philippines Manila, Philippine General Hospital
- Publication Type:Journal Article
- Keywords:
Critical illness-related corticosteroid insufficiency
- MeSH:
Shock;
Adrenal Cortex Hormones;
Hydrocortisone
- From:
Journal of the ASEAN Federation of Endocrine Societies
2022;37(1):14-23
- CountryPhilippines
- Language:English
-
Abstract:
Objectives:The diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) remains a challenge. This initiative aimed to develop a protocol for the diagnosis and management of CIRCI which will facilitate informed decision-making among clinicians through consensus-building among a multi-disciplinary team.
Methodology:This was a single-center, qualitative study which utilized the modified Delphi method, consisting of a sequential iterative process with two rounds of voting. A cut-off value of 70% was set as the threshold for reaching consensus.
Results:The protocol on the diagnosis and management of CIRCI was approved after two rounds of voting, with all the components reaching 83.3%-100% agreement. This protocol on CIRCI provided a framework for the clinical approach to refractory shock. It was advocated that all cases of probable CIRCI should immediately be started on hydrocortisone at 200 mg/day. The definitive diagnosis of CIRCI is established through a random serum cortisol <10 mcg/dL or increase in cortisol of <9 mcg/dL at 60 minutes after a 250 mcg ACTH stimulation test in patients with indeterminate random cortisol levels
Conclusion:The presence of refractory shock unresponsive to fluid resuscitation and vasopressors should warrant the clinical suspicion for the existence of CIRCI and should trigger a cascade of management strategies.
- Full text:1195-Article Text-17277-2-10-20220529.pdf
