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- Critical illness-related corticosteroid insufficiency: latest pathophysiology and management guidelines
- Fremita Chelsea Fredrick, Anish Kumar Reddy Meda, Bhupinder Singh, Rohit Jain
- Acute Crit Care. 2024;39(3):331-340. Published online August 30, 2024
- DOI: https://doi.org/10.4266/acc.2024.00647
- 65,535 View
- 3,225 Download
- 14 Web of Science
- 18 Crossref
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Abstract
PDF - Intensive care unit (ICU) admissions in the United States exceed 5.7 million annually, often leading to complications such as post-intensive care syndrome and high mortality rates. Among these challenges, critical illness-related corticosteroid insufficiency (CIRCI) requires emphasis due to its complex, multiple-cause pathophysiology and varied presentations. CIRCI, characterized by adrenal insufficiency during critical illness, presents in up to 30% of ICU patients and may manifest as an exaggerated inflammatory response. Factors such as dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, altered cortisol metabolism, tissue corticosteroid resistance, and drug-induced suppression contribute to CIRCI. Diagnosis is a complex process, relying on a comprehensive assessment including clinical presentation, laboratory findings, and dynamic stimulatory testing. Treatment involves intensive medical care and exacting glucocorticoid therapy. Recent guidelines advocate for individualized approaches tailored to patient presentation and etiology. Understanding the pathophysiology and treatment of CIRCI is vital for clinicians managing critically ill patients and striving to improve outcomes. This research paper aims to explore the latest developments in the pathophysiology and management of CIRCI.
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Citations
Citations to this article as recorded by
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Xinlong Zhang, Kaizong Huang, Zixin Wu, Rui Ding, Junming Han, Yuan Zhang, Yaping Lu, Yingmei Lu, Yanna Si
Pharmacology & Therapeutics.2026; 278: 108971. CrossRef - Brain-Region-Mediated Neuroimmune Modulation in Sepsis: Research Advances and Therapeutic Prospects
Xuechun Zhou, Ying Tang, Hui Chen, Wei Huang, Haibo Qiu
Journal of Inflammation Research.2026; Volume 19: 1. CrossRef - Higher Serum Cortisol is Associated with Delayed Shock Resolution in Septic Shock Patients
Sophon Dumrongsukit, Suranut Charoensri, Kamonwan Mulalin, Anupol Panitchote
Journal of Intensive Care Medicine.2026; 41(10): 986. CrossRef - Trajectories of mean arterial pressure/norepinephrine equivalent dose index in patients with septic shock receiving low-dose hydrocortisone: a retrospective cohort study in Thailand
Auttawut Chalermwutanon, Sawangjit Saejaow, Veerapong Vattanavanit
Acute and Critical Care.2026; 41(1): 107. CrossRef - Neuroendocrine Balance Index: an Indicator of Metabolic Response to Surgical Stress in Cardiac Surgery
Lada O. Sobanska, Volodymyr I. Cherniy
Ukrainian Journal of Cardiovascular Surgery.2026; 34(1): 119. CrossRef - The cortisol stress response following surgery for proximal femur fractures in geriatric patients – a prospective pilot study
Maximilian M. Menger, Laura E. Streck, Benedikt J. Braun, Steven C. Herath, Christof K. Audretsch, Maximilian Bamberg, Michael D. Menger, Tina Histing, Johann Fontana
Frontiers in Endocrinology.2026;[Epub] CrossRef - Managing sepsis in the era of precision medicine: a narrative review
Ho Jin Yong, Sung Min Kim, Dohhyung Kim
Acute and Critical Care.2026; 41(2): 189. CrossRef - Cardiovascular and neuroendocrine dynamics in antibiotic dose individualization in intensive care
Mehmet Ertugrul Balkar
British Journal of Clinical Pharmacology.2026; 92(10): 3694. CrossRef - Uso racional y basado en la evidencia de glucocorticoides y mineralocorticoides en pacientes con choque séptico en la Unidad de Cuidados Intensivos
Iván Pérez, María Camila Paredes, Oscar Leonardo Tórra, Andrés Sánchez
Medicina Crítica.2026; 40(2): 142. CrossRef - MiR-144 regulates glucocorticoid sensitivity in acute respiratory distress syndrome via the GRβ/NF-κB axis
Shukun Hong, Yi Han, Hongye Wang, Xiaoguang Fan, Wenli Liu, Lujun Qiao, Lu Jiang, Jian Liu
Steroids.2026; 235-236: 109836. CrossRef - Severe Gastrointestinal Disease in a Dog Presenting With Hypoadrenocorticism‐Like Electrolyte Derangements Due to Protothecosis
Rachel G. Angles, Courtney M. Peck, Pamela Mouser, Patty Ewing, Daniela Ackley
Journal of Veterinary Emergency and Critical Care.2026; 36(4): 557. CrossRef - Sepsis as CNS-governed metabolic triage
Barış Yurtsever, Demet Demirkol
Frontiers in Immunology.2026;[Epub] CrossRef - Physiological Influence of Licorice Extract on Some Hormonal and Biochemical Parameters Alterations Induced by Glucocorticoid in Male Rats
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Ricos Biology.2025; 3(2): 19. CrossRef - Adrenal Insufficiency After Glucocorticoid Use in the Pediatric Intensive Care Unit
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Ja Hye Kim
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Nature Medicine.2025; 31(12): 4119. CrossRef - Cortisol Testing in Septic Shock: An Evaluation of Diagnostic Performance and Predictors of Corticosteroid Use in a Middle Eastern Cohort
Fayez Alshamsi, Saeed Alkaabi, Maryam Nasser Mohamedali Alfadli, Naser Abdulla Naser Salem Alshkeili, Sultan Majed Ibrahim Alhosani, Adnan Agha
Diagnostics.2025; 15(20): 2588. CrossRef - Integration of the hypothalamic–pituitary–adrenal and hypothalamic–pituitary–thyroid axes in immunometabolic allostasis of the acute phase of inflammation: A unified cytokine-mediated regulatory complex
O.M. Biletska, Ye.V. Garyachiу, O.V. Markovska, S.I. Latohuz, A.S. Shevchenko
Medicine Today and Tomorrow.2025; 4(94): 86. CrossRef
- Sepsis-associated encephalopathy: Unraveling molecular mechanisms, emerging therapeutics, and translational frontiers
- Pulmonary
- Beyond survival: understanding post-intensive care syndrome
- Lovish Gupta, Maazen Naduthra Subair, Jaskaran Munjal, Bhupinder Singh, Vasu Bansal, Vasu Gupta, Rohit Jain
- Acute Crit Care. 2024;39(2):226-233. Published online May 24, 2024
- DOI: https://doi.org/10.4266/acc.2023.01158
- 37,641 View
- 1,131 Download
- 25 Web of Science
- 28 Crossref
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Abstract
PDF
- Post-intensive care syndrome (PICS) refers to persistent or new onset physical, mental, and neurocognitive complications that can occur following a stay in the intensive care unit. PICS encompasses muscle weakness; neuropathy; cognitive deficits including memory, executive, and attention impairments; post-traumatic stress disorder; and other mood disorders. PICS can last long after hospital admission and can cause significant physical, emotional, and financial stress for patients and their families. Several modifiable risk factors, such as duration of sepsis, delirium, and mechanical ventilation, are associated with PICS. However, due to limited awareness about PICS, these factors are often overlooked. The objective of this paper is to highlight the pathophysiology, clinical features, diagnostic methods, and available preventive and treatment options for PICS.
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Citations
Citations to this article as recorded by- Bodily and Cognitive Experience in Patients With Sepsis and Delirium or Subsyndromal Delirium
Evelyn Álvarez Espinoza, Natalia Castillo‐Núñez, Pablo Olivares Araya, Renata Francisca Olate Barnech, Valentina Vallejos Salfate
Nursing in Critical Care.2026;[Epub] CrossRef - Post–intensive care syndrome: From diagnosis to treatment
Claudia Denke, Karin Steinecke, Henning Krampe, Désirée J. Boehnke, Björn Weiß, Claudia Spies
Deutsches Ärzteblatt international.2026;[Epub] CrossRef - Post‐intensive care syndrome after critical illness: incidence and predictors in a nationwide cohort
Tak Kyu Oh, In‐Ae Song
Anaesthesia.2026; 81(6): 810. CrossRef - A care transition measure for post-intensive care syndrome (PICS) survivors following cardiac surgery: a commentary
Monica Parry
European Journal of Cardiovascular Nursing.2026; 25(2): 398. CrossRef - Assessing Caregiver Needs of Critically-lll Children With Noncancer Diagnoses: A Qualitative Study
Christina Tempesta, Erika Abramson, Jennifer A. Salant
Journal of Pain and Symptom Management.2026; 72(1): 60. CrossRef - Post-intensive Care Syndrome (PICS): an American Association for the Surgery of Trauma Critical Care Committee Consensus Guideline – Defining, Recognizing, and Managing PICS Associated Physical Impairment, Cognitive Dysfunction, and Thromboinflammatory Dy
Jeffrey Anderson, Eden A Nohra, Anna Liveris, Rachel Appelbaum, Asanthi Ratnasekera, Ruben Peralta, Jason Young, Jordan Michael Kirsch, Randeep Jawa, Susan McLean, Bryce Robinson, Joseph Cuschieri
Trauma Surgery & Acute Care Open.2026; 11(2): e002172. CrossRef - Dyspnoe bei invasiv beatmeten Patientinnen und Patienten: eine Übersicht
Benjamin Neetz, Philipp Höger, Franziska Kaestner, Felix Herth, Franziska Trudzinski
Pneumologie.2026;[Epub] CrossRef - Current concepts on feeding the critically ill patient: a narrative review
Michael Adolph, Arthur R. H. van Zanten, Mette M. Berger, Sirak Petros, Michael Hiesmayr, Arved Weimann, Marc E. Martignoni, Katharina Feil, Simon Hirschberger, Valerie Haller, Carla Wunderle
Critical Care.2026;[Epub] CrossRef - Routine Infection Biomarkers and Early Prediction of Post-sepsis Disability: A Narrative Review and Conceptual Framework for Adult and Paediatric Survivors
Saeed M. Kabrah, Arwa F. Flemban, Angham Ahmed Almakki
Journal of Disability Research.2026;[Epub] CrossRef - From early warning to endotype-guided care in sepsis: A critical narrative review of AI, multi-omics, and clinical translation
Shengze Wu, Suibi Yang, Jie Yang, Pengmin Zhou, Hongjie Shen, Zhongheng Zhang
Intensive Care Science.2026; 1: 30. CrossRef - Korean Clinical Practice Guidelines for Rehabilitation in Critically Ill Patients and Post-Intensive Care Syndrome
Chi Ryang Chung, Hye Ju Yeo, Jong Geol Do, Yoonju Na, Eunjeong Choi, Jiyeon Kang, Jeong-Yi Kwon, Hyun Jung Kim, Jinyoung Park, Hak-Jae Lee, Myung Hun Jang, Seung-Tak Kang, Kyung Hyup Koo, Young Seok Kim, Won Kim, Tae-Yoon Kim, Jiyoun Park, Jaewon Beom, Ky
Annals of Rehabilitation Medicine.2026; 50(4): 197. CrossRef - Evaluation for delirium and cognitive function in intensive care unit: reliability and validity of the Jikei Command following Scale in Japan
Masachika Niimi, Yuki Hasegawa, Kensuke Taguchi, Hiroshi Ito, Kenji Higuchi, Masahiro Abo
Acute and Critical Care.2026; 41(3): 621. CrossRef - Korean clinical practice guidelines for rehabilitation in critically ill patients and post-intensive care syndrome
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Acute and Critical Care.2026; 41(3): 439. CrossRef - Early sitting within 72 hours in the intensive care unit and post–intensive care outcomes: a multicenter cohort study
Shinichi Watanabe, Yuki Iida, Yorihide Yanagita, Ayato Shinohara, Tomoyuki Morisawa, Ryo Kozu, Yusuke Kawai, Junji Hatakeyama, Shigeaki Inoue, Osamu Nishida
Annals of Intensive Care.2026; : 100181. CrossRef - Post-COVID microvascular dysfunction in hospitalized COVID-19 survivors is associated with acute disease severity and persistent cognitive complaints
Noa van der Knaap, Simona Klinkhammer, Alida A. Postma, Johanna M.A. Visser-Meily, Janneke Horn, Caroline M. van Heugten, Paulien H.M. Voorter, Merel M. van der Thiel, Gerhard S. Drenthen, Walter H. Backes, Frank van Rosmalen, Susanne van Santen, Bas C.T.
Journal of the Neurological Sciences.2025; 472: 123464. CrossRef - Comparing virtual reality with traditional methods in cognitive rehabilitation in PICS syndrome
A. Despoti, I. Patsaki, A. Alexandropoulou, E. Magkouti, D. Tzoumi, N. Leventakis, G. Roussou, Α. Papathanasiou, N. Dimitriadi, P. Presvelou, S. Nanas, E. Karatzanos
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International Journal of Nursing Practice.2025;[Epub] CrossRef - Factors Associated with Post-Intensive Care Syndrome in Patients Attending a Hospital in Northern Colombia: A Quantitative and Correlational Study
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American Journal of Physiology-Endocrinology and Metabolism.2025; 329(5): E663. CrossRef - “Lost in Transition”: Informational Needs of Sepsis Survivors and Their Relatives Across the Care Trajectory—A Qualitative Study
Frank Vahl, Susanne Ullmann, Lea Draeger, Lena Kannengießer, Mathias W. Pletz, Claudia T. Matthaeus-Kraemer, Carolin Fleischmann-Struzek
Journal of Clinical Medicine.2025; 15(1): 91. CrossRef
- Bodily and Cognitive Experience in Patients With Sepsis and Delirium or Subsyndromal Delirium
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