New Guidelines – Glucocorticoids for Sepsis, ARDS, and CAP

July 1, 2024

Written by Caitlin Nicholson

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The only strong recommendation for corticosteroid use was in patients needing to be hospitalized with severe community acquired pneumonia. The panel recommended against high-dose/short duration corticosteroids in patients with septic shock.

Emergent ‘roids?
This article outlines a systematic review of best available evidence on the use of corticosteroids in sepsis, acute respiratory distress syndrome (ARDS), and community-acquired pneumonia (CAP). Recommendations and grading were based on five focused Population, Intervention, Control and Outcomes (PICO) questions as well as an evaluation of certainty of evidence. These were reviewed by a 22-member panel to formulate four formal recommendations.

• Strong recommendation for use of corticosteroids in hospitalized patients with severe CAP
• Conditional recommendation for use of corticosteroids in patients with septic shock
• Conditional recommendation for use of corticosteroids in patients with ARDS
• Recommendation against use of  high-dose/short duration corticosteroids in patients with septic shock (defined as >400mg/d hydrocortisone equivalent for less than 3 days)

How will this change my practice?
I recently reviewed a meta-analysis regarding steroids and CAP, which provided similar recommendations. Unless the ED is experiencing multi-day boarding of severe CAP patients, I will strongly consider but likely leave the use of steroids in these patients to the hospital team, as steroids are not a completely benign medication. I will also consider judicious use in patients with sepsis plus ARDS or sepsis plus CAP. I am interested to see future studies elucidating a preferred corticosteroid molecule and dosing in these patient populations.

Editor’s note: For septic shock, I would add fludrocortisone 50mcg enterally daily to hydrocortisone 50mg IV Q6h. ~Clay Smith

Source
2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia. Crit Care Med. 2024 May 1;52(5):e219-e233. doi: 10.1097/CCM.0000000000006172. Epub 2024 Jan 19. PMID: 38240492