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Circi
The document discusses recommendations for using steroids in various critical illnesses based on the concept of critical illness-related corticosteroid insufficiency (CIRCI). It recommends suspecting CIRCI in septic shock patients requiring norepinephrine doses over 0.1 mcg/kg/min and using hydrocortisone at under 400 mg/day for at least 3 days. For early acute respiratory distress syndrome (ARDS) with a ratio of oxygen partial pressure to fractional inspired oxygen under 200, it recommends using methylprednisolone at 1 mg/kg for up to 7 days, or 2 mg/kg for persistent ARDS after 6 days with a slow taper over 14 days. It notes no role for steroids
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Circi
- 1. Dr Imran gafoor Depttof critical care medicine RKCH,Raipur CG
- 2. - characterizedby dysregulated systemic inflammation resulting from inadequate intracellular glucocorticoid mediated anti-inflammatory activity for severity of pt’s critical illness, CIRCI is relative adrenal insufficiency due to HPA axis dysfunction (Washington manual 3 ed) Hypotension not responsive to fluids,requiring pressors – mc icu manifestation of adrenal insufficiency
- 18. Suspect CIRCIin septic shock with norepi> 0.1mcg/kg/min requirements Use hydrocort < 400 mg/day for ≥ 3 days for septic shock(no tapering required) Use methylpred 1 mg/kg for early ARDS (P/F < 200; upto 7 days of onset) : or 2 mg/kg for persistent ARDS (after 6 days of onset) f/b slow tapering over 14 days No role of steroids in trauma,influenza Use < 400 mg hydrocort for 5-7 days in CAP Use 0.4 mg/kg iv dexa for 2 days in CA bacterial meningitis Use steroids in CPB,cardiac arrests