The Development of a Protocol for Critical Illness-Related Corticosteroid Insufficiency (CIRCI) at a Tertiary
Anna Elvira Arcellana1, Kenneth Wilson Lim2, Marlon Arcegono3
1Division of Endocrinology, Diabetes and Metabolism, University of the Philippines Manila, Philippine General Hospital.
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.
Related Concept Videos
Nephrotic Syndrome III : Nursing Management
COPD: Management Using Bronchodilators and Corticosteroids
Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
Acute Coronary Syndrome IV: Interprofessional Care
Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Acute Kidney Injury V: Interprofessional Care


