In 2024, the Society of Critical Care Medicine (SCCM) released a “focused update” for their two-part, 2017/2018 guidelines, Guidelines for the Diagnosis and Management of Critical Illness-related Corticosteroid Insufficiency (CIRCI) in Critically Ill Patients, which was a joint release between SCCM and the European Society of Intensive Care Medicine.

The new 2024 guidelines have a narrowed focus as evident by their title: 2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia. The previous guidelines featured sepsis and acute respiratory distress syndrome in part 1, and community-acquired pneumonia in part 2. 

With new evidence available regarding the use of corticosteroids in sepsis, acute respiratory distress syndrome, and community-acquired pneumonia, SCCM felt it all warranted an update. With a focus on the use of corticosteroids in hospitalized adults, the SCCM assembled a 22-member expert panel and developed four recommendations regarding the use of corticosteroids in adult patients with sepsis, acute respiratory distress syndrome, and community-acquired pneumonia.

The following is an overview of the key differences between the three guidelines, as well as the latest insight and major recommendations from the 2024 update.

Guidelines Referenced:

2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia

Diagnosis and Management of Critical Illness-Related Corticosteroid Insufficiency (CIRCI) In Critically Ill Patients (Part 1)

Diagnosis and Management of Critical Illness-Related Corticosteroid Insufficiency (CIRCI) in Critically Ill Patients (Part 2)

Major Changes and Key Takeaways (Earliest Year–Latest Year)
  • The 2017/2018 update considers both adult and pediatric patients. The 2024 update focuses on adult patients.
  • The 2024 update features four recommendations, down from the 2017/2018 guidelines’ combined 16.
  • Recommendations 1A, 1B, 2A, 3A represent the four key recommendations in the 2024 update. 
  • A statement 3B is provided as a “No recommendation” and states, “We make “no recommendation” for administering corticosteroids for adult patients hospitalized with less severe bacterial community-acquired pneumonia.”
The Four Key 2024 Recommendations:

1A. We “suggest” administering corticosteroids to adult patients with septic shock. Conditional recommendation, low certainty evidence.

1B. We “recommend against” administration of high dose/short duration corticosteroids (> 400 mg/d hydrocortisone equivalent for less than 3 d) for adult patients with septic shock. Strong recommendation, moderate certainty evidence.

2A. We “suggest” administering corticosteroids to adult hospitalized patients with acute respiratory distress syndrome. Conditional recommendation, moderate certainty evidence.

3A. We “recommend” administering corticosteroids to adult patients hospitalized with severe bacterial community-acquired pneumonia. Strong recommendation, moderate certainty evidence. 

Comparative Statements from the 2017/2018 Guidelines with Notes on 2024 Update:
  • 2017: If using corticosteroids for septic shock, we suggest using long course and low dose (e.g., IV hydrocortisone <400 mg/day for at ≥3 days at full dose) rather than high dose and short course in adult patients with septic shock.
    • The 2024 update was adjusted because the panel decided that current evidence shows the benefit of corticosteroids in patients with septic shock requiring vasopressors, regardless of dose.
  • 2017: We suggest use of corticosteroids in patients with early moderate to severe acute respiratory distress syndrome (PaO2/FiO2 of <200 and within 14 days of onset).
    • Since the 2017/2018 guidelines were published, updated analysis did not demonstrate a differential effect based on corticosteroid timing or type or dosage [including in direct head-to-head comparisons].
  • 2018: We suggest the use of corticosteroids for 5−7 days at a daily dose < 400 mg IV hydrocortisone or equivalent in hospitalized patients with community-acquired pneumonia.
    • The 2024 update recognizes that there are multiple acceptable dosing strategies for clinicians to consider.

We hope you enjoyed this insightful breakdown of how SCCM's 2024 guidelines on the use of corticosteroids has evolved over the years.

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