CIRCI is defined as inadequate corticosteroid activity for the severity of illness of a patient
CIRCI arises due to steroid tissue resistance and inadequate circulating levels of free cortisol
Hypotension refractory to fluids and requirement of vasopressors is the primary manifestation of CIRCI
In contrast to chronic adrenal insufficiency, hyponatremia and hyperkalemia are uncommon
Consider CIRCI in all critically ill patients requiring vasopressor support
So, which critically ill patients do you treat with steroids? Current literature suggests the indications for steroid treatment include vasopressor dependent septic shock and persistent ARDS despite supportive therapy and lung protective ventilation. A patient who requires only an hour or two of a vasopressor while being fluid resuscitated is unlikely to benefit. An accepted dosing schedule is hydrocortisone 50 mg IV every 6 hours.
