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Corticosteroids in Septic Shock and ARDS

Corticosteroids in Septic Shock and ARDS: Critical Illness - Consider Corticosteroids → Identify Indication → Septic Shock → Septic Shock: Hydrocortison...

Pathway Overview

13 steps

Algorithm Steps

13 total

  1. 01Start

    Critical Illness - Consider Corticosteroids

    Septic shock, ARDS, or severe CAP

  2. 02Decision

    Identify Indication

    Which condition is being treated?

  3. 03Action

    Septic Shock

    Requiring vasopressors

    • SCCM 2024: Suggest corticosteroids
    • (Conditional recommendation, low certainty)
  4. 04Action

    Septic Shock: Hydrocortisone

    For vasopressor-dependent shock

    • Hydrocortisone 200-300 mg/day
    • Options: 50mg IV q6h OR continuous infusion
    • Duration: 5-7 days, then taper
    • Start when NE ≥0.25 mcg/kg/min
    • ⚠️ AVOID high dose short duration (>400mg/day <3 days)
  5. 05Warning

    ⚠️ Avoid High-Dose/Short Duration

    Strong recommendation AGAINST

    • Do NOT give >400mg hydrocortisone equiv/day
    • Do NOT give for <3 days
    • Associated with worse outcomes
    • Rebound hypotension risk
  6. 06Action

    Monitoring on Steroids

    Watch for adverse effects

    • Blood glucose (insulin often needed)
    • Secondary infections
    • Hypernatremia
    • GI bleeding prophylaxis
    • Neuromuscular weakness with prolonged use
  7. 07Action

    Taper and Discontinue

    Avoid abrupt discontinuation

    • Taper over 2-4 days
    • Or stop after 5-7 days if short course
    • Monitor for rebound hypotension
    • No cosyntropin stimulation test needed routinely
  8. 08Outcome

    Shock Resolving / ARDS Improving

    Wean vasopressors, continue care

  9. 09Outcome

    No Clear Benefit

    Continue supportive care, steroids may still be continued

  10. 10Action

    ARDS

    Hospitalized with ARDS

    • SCCM 2024: Suggest corticosteroids
    • (Conditional recommendation, moderate certainty)
  11. 11Action

    ARDS: Corticosteroids

    Various regimens used

    • Dexamethasone 20mg daily x5d, then 10mg x5d
    • OR Methylprednisolone 1-2 mg/kg/day
    • Duration: 7-14 days, taper
    • No consensus on optimal regimen
    • Consider for moderate-severe ARDS
  12. Path rejoins step 06Shared downstream outcome
  13. 12Action

    Severe CAP

    Hospitalized with severe bacterial pneumonia

    • SCCM 2024: Recommend corticosteroids
    • (Strong recommendation, moderate certainty)
  14. 13Action

    Severe CAP: Corticosteroids

    Strong recommendation

    • Hydrocortisone 200mg/day
    • OR Methylprednisolone 40mg/day
    • OR Dexamethasone 6mg/day
    • Duration: 4-7 days
    • Start within 24h of admission
  15. Path rejoins step 06Shared downstream outcome

Guideline Source

2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, ARDS, and Community-Acquired Pneumonia

DOI: 10.1097/CCM.0000000000006172View Guideline

Clinical Safety Information

Clinical Decision Support — Not a Substitute for Clinical Judgment

Individual patient factors may require deviation from these recommendations.

Known Limitations

  • Does not address steroid use for other indications (asthma, COPD exacerbation)
  • Optimal dose and duration not definitively established
  • Monitor for hyperglycemia and secondary infections
  • Does not cover adrenal insufficiency workup
  • Risk of neuromuscular weakness with prolonged use

Contraindicated Populations

pediatric

Applicable Regions

USEUGlobal

Global: SCCM 2024 focused update

Version 1Next review: 2028-01-01

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Frequently Asked Questions

What is the Corticosteroids in Septic Shock and ARDS?

The Corticosteroids in Septic Shock and ARDS is a management clinical algorithm for Critical Care. It provides a structured decision tree to guide clinical decision-making, based on 2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, ARDS, and Community-Acquired Pneumonia.

What guideline is the Corticosteroids in Septic Shock and ARDS based on?

This algorithm is based on 2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, ARDS, and Community-Acquired Pneumonia (DOI: 10.1097/CCM.0000000000006172).

What are the limitations of the Corticosteroids in Septic Shock and ARDS?

Known limitations include: Does not address steroid use for other indications (asthma, COPD exacerbation); Optimal dose and duration not definitively established; Monitor for hyperglycemia and secondary infections; Does not cover adrenal insufficiency workup; Risk of neuromuscular weakness with prolonged use. Individual patient factors may require deviation from these recommendations.

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