Diagnosis and Management of Critical Illness-Related Corticosteroid Insufficiency (CIRCI) in Critically Ill Patients (Part I)

The task force makes no recommendation regarding whether to use delta cortisol (change in baseline cortisol at 60 min of <9 μg/dL) after cosyntropin (250 μg) administration or a random plasma cortisol of <10 μg/dL for the diagnosis of CIRCI. (, )

We suggest against using plasma free cortisol level rather than plasma total cortisol for the diagnosis of CIRCI. ( Conditional , Very Low )

We suggest against using salivary rather than serum cortisol for diagnosing CIRCI. ( Conditional , Very Low )

We suggest that the high-dose (250-μg) rather than the low-dose (1-μg) ACTH stimulation test be used for the diagnosis of CIRCI. ( Conditional , Low )

We suggest the use of the 250-μg ACTH stimulation test rather than the hemodynamic response to hydrocortisone (50–300 mg) for the diagnosis of CIRCI. ( Conditional , Very Low )

We suggest against using corticotropin levels for the routine diagnosis of CIRCI. ( Conditional , Low )