Critical illness-related corticosteroid insufficiency (CIRCI): a narrative review from a Multispecialty Task Force of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM)
- 21.09.2017
- Review
Erschienen in:
- Verfasst von
- Djillali Annane
- Stephen M. Pastores
- Wiebke Arlt
- Robert A. Balk
- Albertus Beishuizen
- Josef Briegel
- Joseph Carcillo
- Mirjam Christ-Crain
- Mark S. Cooper
- Paul E. Marik
- Gianfranco Umberto Meduri
- Keith M. Olsen
- Bram Rochwerg
- Sophia C. Rodgers
- James A. Russell
- Greet Van den Berghe
- Erschienen in
- Intensive Care Medicine | Ausgabe 12/2017
Abstract
Objective
To provide a narrative review of the latest concepts and understanding of the pathophysiology of critical illness-related corticosteroid insufficiency (CIRCI).
Participants
A multispecialty task force of international experts in critical care medicine and endocrinology and members of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM).
Data sources
Medline, Database of Abstracts of Reviews of Effects (DARE), Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews.
Results
Three major pathophysiologic events were considered to constitute CIRCI: dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis, altered cortisol metabolism, and tissue resistance to glucocorticoids. The dysregulation of the HPA axis is complex, involving multidirectional crosstalk between the CRH/ACTH pathways, autonomic nervous system, vasopressinergic system, and immune system. Recent studies have demonstrated that plasma clearance of cortisol is markedly reduced during critical illness, explained by suppressed expression and activity of the primary cortisol-metabolizing enzymes in the liver and kidney. Despite the elevated cortisol levels during critical illness, tissue resistance to glucocorticoids is believed to occur due to insufficient glucocorticoid alpha-mediated anti-inflammatory activity.
Conclusions
Novel insights into the pathophysiology of CIRCI add to the limitations of the current diagnostic tools to identify at-risk patients and may also impact how corticosteroids are used in patients with CIRCI.
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- Titel
- Critical illness-related corticosteroid insufficiency (CIRCI): a narrative review from a Multispecialty Task Force of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM)
- Verfasst von
-
Djillali Annane
Stephen M. Pastores
Wiebke Arlt
Robert A. Balk
Albertus Beishuizen
Josef Briegel
Joseph Carcillo
Mirjam Christ-Crain
Mark S. Cooper
Paul E. Marik
Gianfranco Umberto Meduri
Keith M. Olsen
Bram Rochwerg
Sophia C. Rodgers
James A. Russell
Greet Van den Berghe
- Publikationsdatum
- 21.09.2017
- Verlag
- Springer Berlin Heidelberg
- Erschienen in
-
Intensive Care Medicine / Ausgabe 12/2017
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238 - DOI
- https://doi.org/10.1007/s00134-017-4914-x
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