Steroids in the acutely ill: Evolving recommendations and practice.

Critical illness-related corticosteroid insufficiency (CIRCI) is a state of systemic inflammation involving dysregulation of the hypothalamic-pituitary-adrenal axis, altered cortisol metabolism, and tissue resistance to corticosteroids. Many conditions may be associated with CIRCI, including sepsis, septic shock, acute respiratory distress syndrome, and severe community-acquired pneumonia. Recommendations and practice for diagnosing and treating this condition have evolved as information has emerged. Here, the author reviews the current thinking.