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CIRCI Hydrocortisone Dose — FRCA Final MCQ

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ModerateIntensive Care MedicineCIRCI Hydrocortisone DoseFRCA Final

A 55-year-old man (ASA III) develops critical illness-related corticosteroid insufficiency (CIRCI) in ICU. According to SSC 2021, what dose of hydrocortisone is recommended?

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Correct answer: AHydrocortisone 200 mg/day (continuous infusion or 50 mg QDS)

SSC 2021 guidelines recommend IV hydrocortisone 200 mg/day (given as either continuous infusion or 50 mg every 6 hours) for adults with septic shock who have ongoing vasopressor requirements despite adequate fluid resuscitation and vasopressor therapy. This 'stress dose' replaces the physiological cortisol production. Fludrocortisone 50 mcg/day may be added (APROCCHSS trial). Steroids should be weaned once vasopressors are discontinued. ACTH stimulation testing is NOT required before initiating treatment.

Reference: SSC – 2021 – International guidelines; Annane D et al – 2018 – APROCCHSS trial