Critical illness-related corticosteroid insufficiency (CIRCI)

Reference:　https://insights.ovid.com/pubmed?pmid=28938253

難以用單一test診斷, 但臨床醫師可以用 high dose ACTH stimulation test

(給cosyntropin (250 μg)後60分鐘cortisol改變< 9 μg/dL)

或是random plasma cortisol ( < 10 μg/dL ) 來判斷

用plasma total cortisol 比free cortisol或salivary cortisol好

Sepsis:

沒有shock不要用

考慮用在septic shock且對fluid /moderate-high dose vasopressor沒反應者

有要用的話用low dose, long duration ( IV hydrocortisone < 400 mg/day for ≥ 3 days at full dose )

Early moderate/ severe ARDS: IV methylprednisolone 1 mg/kg/day

Major trauma: 不建議用corticosteroids