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

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.

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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

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