Practice variability in the assessment and treatment of critical illness-related corticosteroid insufficiency.
OBJECTIVE
Little is known about how published evidence regarding use of steroids in septic shock has been incorporated into clinical practice.


METHODS
All patients admitted to an intensive care unit at a single, tertiary-care, academic medical center from November 1, 2004, through February 28, 2005, were screened using the hospital's computerized pharmacy database to determine if they had received at least 1 qualifying medication: cosyntropin, fludrocortisone, hydrocortisone, or dopamine, epinephrine, or norepinephrine as a vasopressor infusion.


RESULTS
Only 58% (95% confidence interval, 47%-69%) of the 81 patients who met criteria for vasopressor-dependent septic shock (VDSS) were evaluated for critical illness-related corticosteroid insufficiency. Forty-seven percent of the 81 patients who met the criteria for VDSS and 49% of the 47 patients who did not meet the criteria for VDSS were treated with corticosteroids. Nearly all (85%; 95% confidence interval, 72%-94%) patients who did not meet the criteria for VDSS received an adrenocorticotropic hormone test.


CONCLUSIONS
Treatment and evaluation of critical illness-related corticosteroid insufficiency in critically ill patients at our institution are inconsistent. Many patients with VDSS do not receive either treatment or evaluation for critical illness-related corticosteroid insufficiency, and patients who do not meet the current criteria are being evaluated and/or treated for critical illness-related corticosteroid insufficiency.
Department of Pharmacy, Harborview Medical Center, Box 359885, Seattle, WA 98104, USA. karir@u.washington.edu
Veena
V
Karir
Colin R
CR
Cooke
Liane
L
Andersson
Ellen
E
Caldwell
Gordon D
GD
Rubenfeld
D000046:Academic Medical Centers; D000305:Adrenal Cortex Hormones / Q000172:deficiency / Q000627:therapeutic use*; D000309:Adrenal Insufficiency / Q000175:diagnosis* / Q000209:etiology; D016638:Critical Illness; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012772:Shock, Septic / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D013256:Steroids / Q000627:therapeutic use; D014861:Washington
D000305:Adrenal Cortex Hormones; D013256:Steroids