2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia

被引：38

作者：

Chaudhuri, Dipayan ^{[1
,2
]}

Nei, Andrea M. ^{[3
]}

Rochwerg, Bram ^{[1
,2
]}

Balk, Robert A. ^{[4
]}

Asehnoune, Karim ^{[5
]}

Cadena, Rhonda ^{[6
]}

Carcillo, Joseph A. ^{[7
]}

Correa, Ricardo ^{[8
]}

Drover, Katherine ^{[9
]}

Esper, Annette M. ^{[10
]}

Gershengorn, Hayley B. ^{[11
,12
]}

Hammond, Naomi E. ^{[13
,14
]}

Jayaprakash, Namita ^{[15
,16
]}

Menon, Kusum ^{[17
,18
,19
]}

Nazer, Lama ^{[20
]}

Pitre, Tyler ^{[1
,2
]}

Qasim, Zaffer A. ^{[21
]}

Russell, James A. ^{[22
]}

Santos, Ariel P. ^{[23
]}

Sarwal, Aarti ^{[24
]}

Spencer-Segal, Joanna ^{[25
]}

Tilouche, Nejla ^{[26
]}

Annane, Djillali ^{[27
,28
,29
]}

Pastores, Stephen M. ^{[30
]}

机构：

[1] McMaster Univ, Dept Med, Hamilton, ON, Canada

[2] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[3] Mayo Clin Hosp Rochester, Dept Pharm, Rochester, MN USA

[4] Rush Univ, Med Ctr, Dept Internal Med, Chicago, IL USA

[5] Univ Nantes, Hotel Dieu, CHU Nantes, Pole Anesthesie Reanimat,Serv Anesthesie Reanimat,, F-44093 Nantes, France

[6] Carolinas Med Ctr, Wake Forest Sch Med, Dept Internal Med, Atrium Hlth, Charlotte, NC USA

[7] Univ Pittsburgh, Sch Med, Dept Crit Care Med, Pittsburgh, PA USA

[8] Endocrine & Metab Inst, Dept Endocrinol Diabet & Metab, Cleveland Clin, Cleveland, OH USA

[9] McMaster Univ, Hamilton, ON, Canada

[10] Emory Univ, Div Pulm Allergy Crit Care & Sleep Med, Atlanta, GA USA

[11] Univ Miami Miller Sch Med, Div Pulm Crit Care & Sleep Med, Miami, FL USA

[12] Albert Einstein Coll Med, Div Crit Care Med, Bronx, NY USA

[13] George Inst Global Hlth, Malcolm Fisher Dept Intens Care Med, Crit Care Program, UNSW Sydney, Newtown, NSW, Australia

[14] Royal North Shore Hosp, Malcolm Fisher Dept Intens Care, St Leonards, NSW, Australia

[15] Henry Ford Hosp, Dept Emergency Med, Detroit, MI USA

[16] Henry Ford Hosp, Div Pulm & Crit Care Med, Detroit, MI USA

[17] Univ Ottawa, Div Pediat Crit Care, Ottawa, ON, Canada

[18] Childrens Hosp Eastern Ontario Res Inst, Ottawa, ON, Canada

[19] Univ Ottawa, Dept Pediat, Ottawa, ON, Canada

[20] King Hussein Canc Ctr, Dept Pharm, Amman, Jordan

[21] Univ Penn, Hlth Syst, Philadelphia, PA USA

[22] Univ British Columbia, Pauls Hosp, Dept Med,Div Crit Care, Vancouver, BC, Canada

[23] Texas Tech Univ, Hlth Sci Ctr, Lubbock, TX USA

[24] Atrium Wake Forest Sch Med, Dept Neurol Neurocrit Care, Winston Salem, NC USA

[25] Univ Michigan, Dept Psychiat, Michigan Med, Ann Arbor, MI 48109 USA

[26] Hop Gonesse, Serv Reanimat Polyvalente, Intens Care Unit, Gonesse, France

[27] Assistance Publ Hop Paris, Dept Physiol, Raymond Poincare Hosp, Garches, France

[28] Univ Versailles St Quentin, Univ Paris Saclay, Sch Med Simone Veil, Versaillles, France

[29] Univ Paris Saclay, IHU Prometheus Federat Hosp Univ SEPSIS, INSERM, Garches, France

[30] Mem Sloan Kettering Canc Ctr, Crit Care Ctr, Dept Anesthesiol & Crit Care Med, New York, NY USA

来源：

CRITICAL CARE MEDICINE | 2024年 / 52卷 / 05期

关键词：

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; LOW-DOSE HYDROCORTISONE; PEDIATRIC SEPTIC SHOCK; CARE MEDICINE SCCM; POSTTRAUMATIC-STRESS-DISORDER; INSUFFICIENCY CIRCI; EUROPEAN-SOCIETY; DEXAMETHASONE TREATMENT; GLUCOCORTICOID THERAPY; STEROID-THERAPY; DOUBLE-BLIND;

D O I：

10.1097/CCM.0000000000006172

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

RATIONALE:New evidence is available examining the use of corticosteroids in sepsis, acute respiratory distress syndrome (ARDS) and community-acquired pneumonia (CAP), warranting a focused update of the 2017 guideline on critical illness-related corticosteroid insufficiency.OBJECTIVES:To develop evidence-based recommendations for use of corticosteroids in hospitalized adults and children with sepsis, ARDS, and CAP.PANEL DESIGN:The 22-member panel included diverse representation from medicine, including adult and pediatric intensivists, pulmonologists, endocrinologists, nurses, pharmacists, and clinician-methodologists with expertise in developing evidence-based Clinical Practice Guidelines. We followed Society of Critical Care Medicine conflict of interest policies in all phases of the guideline development, including task force selection and voting.METHODS:After development of five focused Population, Intervention, Control, and Outcomes (PICO) questions, we conducted systematic reviews to identify the best available evidence addressing each question. We evaluated the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach and formulated recommendations using the evidence-to-decision framework.RESULTS:In response to the five PICOs, the panel issued four recommendations addressing the use of corticosteroids in patients with sepsis, ARDS, and CAP. These included a conditional recommendation to administer corticosteroids for 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 for septic shock. In response to the final PICO regarding type of corticosteroid molecule in ARDS, the panel was unable to provide specific recommendations addressing 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 for sepsis, ARDS, and CAP.

引用

页码：e219 / e233

页数：15

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