• Dipayan Chaudhuri, Andrea M Nei, Bram Rochwerg, Robert A Balk, Karim Asehnoune, Rhonda Cadena, Joseph A Carcillo, Ricardo Correa, Katherine Drover, Annette M Esper, Hayley B Gershengorn, Naomi E Hammond, Namita Jayaprakash, Kusum Menon, Lama Nazer, Tyler Pitre, Zaffer A Qasim, James A Russell, Ariel P Santos, Aarti Sarwal, Joanna Spencer-Segal, Nejla Tilouche, Djillali Annane, and Stephen M Pastores.
• Department of Medicine, McMaster University, Hamilton, ON, Canada.
• Crit. Care Med. 2024 May 1; 52 (5): e219e233e219-e233.

RationaleNew 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.ObjectivesTo develop evidence-based recommendations for use of corticosteroids in hospitalized adults and children with sepsis, ARDS, and CAP.Panel DesignThe 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.MethodsAfter 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.ResultsIn 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.ConclusionsThe 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.Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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