Steroids For Critical Illness

From a talk on sensible steroid usage in the ER by Dr Alex Blutinger.

Have you heard about CIRCI? That’s Sepsis/Critical Illness-Related Corticosteroid Insufficiency (CIRCI), where your very sickest patients seem to ‘run out of cortisone’. (Kinda like you at the end of that 14 hour shift…) As we all know from the Addisonian crisis patient - this is not ideal. But how do we know when it’s happening and when to start supplementing steroids?

Dr Alex gave some practical guidelines: 

• A stress-dose steroid administration should be especially considered in volume resuscitated vasopressor-dependent animals, regardless of serum cortisol levels or of ACTH stim results.  

• Use hydrocortisone  at 1–4.3 mg/kg/day, either  divided into 4 equal doses given IV every 6 hours, or as a CRI. 

• You could do an ACTH stimulation to try to confirm the return of normal adrenocortical function, or just start weaning the steroid once you’re able to wean your patent off vasopressors.

For more clinical pearls, sign up for our free weekly Newsletter , or get all of our content on the go with our Clinical Podcasts.