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https://www.sccm.org/Clinical-Resources/Guidelines/Guidelines/Guidelines-on-Use-of-Corticosteroids-in-Sepsis,-Ac
Submission: On February 19 via api from US — Scanned from DE
Submission: On February 19 via api from US — Scanned from DE
Form analysis 3 forms found in the DOM
POST /Clinical-Resources/Guidelines/Guidelines/Guidelines-on-Use-of-Corticosteroids-in-Sepsis,-Ac
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SCCM is performing maintenance on its websites. For the best browsing
experience, please use Microsoft Edge or Safari. Those using Chrome or Firefox
may experience access issues at this time.
SCCM > Clinical Resources > All SCCM Guidelines > Guidelines on Use of
Corticosteroids in Sepsis, ARDS, and CAP
GUIDELINES ON USE OF CORTICOSTEROIDS IN SEPSIS, ACUTE RESPIRATORY DISTRESS
SYNDROME, AND COMMUNITY-ACQUIRED PNEUMONIA
Stephen M. Pastores, MD, FCCM; Djillali Annane, MD, PhD;
Published: 1/5/2024
Chaudhuri D, Nei AM, Rochwerg B, et al. 2024 focused update: guidelines on use
of corticosteroids in sepsis, acute respiratory distress syndrome, and
community-acquired pneumonia. Crit Care Med. Online special article. January 19,
2024. doi: 10.1097/CCM.0000000000006172.
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Guidelines on Use of Corticosteroids in Sepsis, Acute Respiratory Distress
Syndrome, and Community-Acquired Pneumonia
Citation: Chaudhuri D, Nei AM, Rochwerg B, et al. 2024 focused update:
guidelines on use of corticosteroids in sepsis, acute respiratory distress
syndrome, and community-acquired pneumonia. Crit Care Med. Online special
article. January 19, 2024. doi: 10.1097/CCM.0000000000006172.
Jump to Recommendations
RATIONALE: New evidence is available on the use of corticosteroids in sepsis,
acute respiratory distress syndrome (ARDS), and community-acquired bacterial
pneumonia (CAP), warranting a focused update of the 2017 guidelines on critical
illness-related corticosteroid insufficiency.
OBJECTIVES: To develop evidence-based recommendations for the use of
corticosteroids in hospitalized adults and children with sepsis, ARDS, and CAP
PANEL DESIGN: The 22-member panel comprised diverse representation including
adult and pediatric intensivists, pulmonologists, endocrinologists, nurses,
pharmacists, and clinician methodologists with expertise in developing
evidence-based clinical practice guidelines. The panel followed Society of
Critical Care Medicine (SCCM) conflict-of-interest policies in all phases of
guidelines development, including panel selection and voting.
METHODS: After development of five focused population, intervention, comparison,
outcome (PICO) questions, the panel conducted systematic reviews to identify the
best available evidence addressing each question. The panel evaluated the
certainty of evidence using the Grading of Recommendations, Assessment,
Development, and Evaluation (GRADE) approach and formulated recommendations
using the evidence-to-decision framework.
RESULTS: In response to the five PICO questions, the panel issued four
recommendations addressing the use of corticosteroids in patients with sepsis,
ARDS, and CAP, including a conditional recommendation to administer
corticosteroids in patients with septic shock and critically ill patients with
ARDS and a strong recommendation for use in hospitalized patients with severe
CAP. The panel also recommended against high-dose/short-duration administration
of corticosteroids in patients with septic shock. In response to the final PICO
question regarding the type of corticosteroid molecule in ARDS, the panel was
unable to provide specific recommendations about corticosteroid molecule, dose,
and duration of therapy based on currently available evidence.
CONCLUSIONS: The panel provided updated recommendations based on current
evidence to inform clinicians, patients, and other stakeholders on the use of
corticosteroids in patients with sepsis, ARDS, and CAP.
KEYWORDS: Acute Respiratory Distress Syndrome; Grading of Recommendations
Assessment, Development, and Evaluation; community-acquired pneumonia;
corticosteroids; critical illness; development; dose response; glucocorticoids;
grading of recommendations assessment; guidelines; mineralocorticoids; sepsis;
septic shock
Guideline Type: Clinical
Related Resources:
Download
Read Full Guideline
Section:
ARDS
CAP
Sepsis and septic shock
Strength:
Conditional
Strong
We suggest administering corticosteroids to adult patients with septic shock.
Quality of evidence: Low
Sepsis and septic shock Conditional
We recommend against administering high-dose/short-duration corticosteroids (>
400 mg/day hydrocortisone equivalent for < 3 days) for adult patients with
septic shock.
Quality of evidence: Moderate
Sepsis and septic shock Strong
We suggest administering corticosteroids to adult critically ill patients with
ARDS.
Quality of evidence: Moderate
ARDS Conditional
We recommend administering corticosteroids to adult patients hospitalized with
severe bacterial CAP.
Quality of evidence: Moderate
CAP Strong
We make no recommendation for administering corticosteroids to adult patients
hospitalized with less severe bacterial CAP.
CAP hide
ARDS = acute respiratory distress syndrome, CAP = community-acquired pneumonia.
Stephen M. Pastores, MD, FCCM
Stephen M. Pastores, MD, FCCM, is director of the Critical Care Medicine
Fellowship Training and Research Program and vice-chair of education in the
Department of Anesthesiology and Critical Care Medicine at Memorial Sloan
Kettering Cancer Center in New York, New York, USA. He served as cochair of the
corticosteroids guidelines panel.
Djillali Annane, MD, PhD
Djillali Annane, MD, PhD, is dean of the faculty of medicine at the University
of Versailles Paris Saclay and head of the Critical Care Department at Raymond
Poincaré University Hospital in Garches, France. He served as cochair of the
corticosteroids guidelines panel.
A complete list of the guidelines authors and contributors is available within
the published manuscript.
Guidelines
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