@article{Arcellana_Lim_Arcegono_Jimeno_2022, title={The Development of a Protocol for Critical Illness-Related Corticosteroid Insufficiency (CIRCI) at a Tertiary Hospital}, volume={37}, url={https://asean-endocrinejournal.org/index.php/JAFES/article/view/1195}, DOI={10.15605/jafes.037.01.03}, abstractNote={<p><strong>Objectives.</strong> The diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) remains a challenge. This initiative aimed to develop a protocol for the diagnosis and management of CIRCI which will facilitate informed decision-making among clinicians through consensus-building among a multi-disciplinary team.  </p> <p><strong>Methodology.</strong> This was a single-center, qualitative study which utilized the modified Delphi method, consisting of a sequential iterative process with two rounds of voting. A cut-off value of 70% was set as the threshold for reaching consensus.</p> <p><strong>Results.</strong> The protocol on the diagnosis and management of CIRCI was approved after two rounds of voting, with all the components reaching 83.3%-100% agreement. This protocol on CIRCI provided a framework for the clinical approach to refractory shock. It was advocated that all cases of probable CIRCI should immediately be started on hydrocortisone at 200 mg/day. The definitive diagnosis of CIRCI is established through a random serum cortisol <10 mcg/dL or increase in cortisol of <9 mcg/dL at 60 minutes after a 250 mcg ACTH stimulation test in patients with indeterminate random cortisol levels.</p> <p><strong>Conclusion.</strong> The presence of refractory shock unresponsive to fluid resuscitation and vasopressors should warrant the clinical suspicion for the existence of CIRCI and should trigger a cascade of management strategies.</p>}, number={1}, journal={Journal of the ASEAN Federation of Endocrine Societies}, author={Arcellana, Anna Elvira and Lim, Kenneth Wilson and Arcegono, Marlon and Jimeno, Cecilia}, year={2022}, month={Feb.}, pages={14–23} }