Diagnosis and Management of CIRCI in Critically Ill Patients (Part I)

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.

We suggest against using plasma free cortisol level rather than plasma total cortisol for the diagnosis of CIRCI.
Quality of Evidence: Very low

We suggest against using salivary rather than serum cortisol for diagnosing CIRCI.
Quality of evidence: Very low

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.
Quality of evidence: Low

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.
Quality of evidence: Very low

We suggest against using corticotropin levels for the routine diagnosis of CIRCI.
Quality of evidence: Low

We suggest against corticosteroid administration in adult patients with sepsis without shock.
Quality of evidence: Moderate

We suggest using corticosteroids in patients with septic shock that is not responsive to fluid and moderate- to high-dose vasopressor therapy.
Quality of evidence: Low

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.
Quality of evidence: Low

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).
Quality of evidence: Moderate

We suggest against the use of corticosteroids in major trauma.
Quality of evidence: Low