Abstract：
New evidence is available examining the use of corticosteroids in sepsis, acute respiratory distress syndrome (ARDS) and community-acquired pneumonia (CAP), warranting a focused update of the 2017 guideline on critical illness-related corticosteroid insufficiency.
To develop evidence-based recommendations for use of corticosteroids in hospitalized adults and children with sepsis, ARDS, and CAP.
The 22-member panel included diverse representation from medicine, including adult and pediatric intensivists, pulmonologists, endocrinologists, nurses, pharmacists, and clinician-methodologists with expertise in developing evidence-based Clinical Practice Guidelines. We followed Society of Critical Care Medicine conflict of interest policies in all phases of the guideline development, including task force selection and voting.
After development of five focused Population, Intervention, Control, and Outcomes (PICO) questions, we conducted systematic reviews to identify the best available evidence addressing each question. We evaluated the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach and formulated recommendations using the evidence-to-decision framework.
In response to the five PICOs, the panel issued four recommendations addressing the use of corticosteroids in patients with sepsis, ARDS, and CAP. These included a conditional recommendation to administer corticosteroids for patients with septic shock and critically ill patients with ARDS and a strong recommendation for use in hospitalized patients with severe CAP. The panel also recommended against high dose/short duration administration of corticosteroids for septic shock. In response to the final PICO regarding type of corticosteroid molecule in ARDS, the panel was unable to provide specific recommendations addressing corticosteroid molecule, dose, and duration of therapy, based on currently available evidence.
The panel provided updated recommendations based on current evidence to inform clinicians, patients, and other stakeholders on the use of corticosteroids for sepsis, ARDS, and CAP.
To develop evidence-based recommendations for use of corticosteroids in hospitalized adults and children with sepsis, ARDS, and CAP.
The 22-member panel included diverse representation from medicine, including adult and pediatric intensivists, pulmonologists, endocrinologists, nurses, pharmacists, and clinician-methodologists with expertise in developing evidence-based Clinical Practice Guidelines. We followed Society of Critical Care Medicine conflict of interest policies in all phases of the guideline development, including task force selection and voting.
After development of five focused Population, Intervention, Control, and Outcomes (PICO) questions, we conducted systematic reviews to identify the best available evidence addressing each question. We evaluated the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach and formulated recommendations using the evidence-to-decision framework.
In response to the five PICOs, the panel issued four recommendations addressing the use of corticosteroids in patients with sepsis, ARDS, and CAP. These included a conditional recommendation to administer corticosteroids for patients with septic shock and critically ill patients with ARDS and a strong recommendation for use in hospitalized patients with severe CAP. The panel also recommended against high dose/short duration administration of corticosteroids for septic shock. In response to the final PICO regarding type of corticosteroid molecule in ARDS, the panel was unable to provide specific recommendations addressing corticosteroid molecule, dose, and duration of therapy, based on currently available evidence.
The panel provided updated recommendations based on current evidence to inform clinicians, patients, and other stakeholders on the use of corticosteroids for sepsis, ARDS, and CAP.
摘要：
背景：有新的证据可用于检查皮质类固醇在脓毒症中的使用，急性呼吸窘迫综合征（ARDS）和社区获得性肺炎（CAP），保证对2017年关于危重病相关皮质类固醇功能不全的指南进行重点更新。
目的：为败血症住院的成人和儿童使用糖皮质激素制定循证建议，ARDS,和CAP。
■由22名成员组成的小组包括来自医学的各种代表，包括成人和儿科重症医师，肺病学家,内分泌学家,护士,药剂师,以及在制定循证临床实践指南方面具有专业知识的临床医生方法学家。我们在指南制定的所有阶段都遵循了重症监护医学协会的利益冲突政策，包括工作组的选择和投票。
方法：在发展了五个重点人群之后，干预,Control,和结果（PICO）问题，我们进行了系统回顾,以确定解决每个问题的最佳证据.我们使用建议分级评估来评估证据的确定性，发展,和评估方法，并使用证据决策框架提出建议。
结果：针对五个PICOs，小组就脓毒症患者使用皮质类固醇提出了四项建议，ARDS,和CAP。其中包括有条件的建议对感染性休克患者和危重ARDS患者使用皮质类固醇，以及强烈建议对严重CAP住院患者使用皮质类固醇。该小组还建议不要高剂量/短期使用皮质类固醇治疗感染性休克。为了响应关于ARDS中皮质类固醇分子类型的最终PICO，专家组无法提供针对皮质类固醇分子的具体建议，剂量,和治疗的持续时间，根据现有证据。
结论：专家组根据当前证据提供了最新建议，以告知临床医生，病人,以及使用皮质类固醇治疗脓毒症的其他利益相关者，ARDS,和CAP。
目的：为败血症住院的成人和儿童使用糖皮质激素制定循证建议，ARDS,和CAP。
■由22名成员组成的小组包括来自医学的各种代表，包括成人和儿科重症医师，肺病学家,内分泌学家,护士,药剂师,以及在制定循证临床实践指南方面具有专业知识的临床医生方法学家。我们在指南制定的所有阶段都遵循了重症监护医学协会的利益冲突政策，包括工作组的选择和投票。
方法：在发展了五个重点人群之后，干预,Control,和结果（PICO）问题，我们进行了系统回顾,以确定解决每个问题的最佳证据.我们使用建议分级评估来评估证据的确定性，发展,和评估方法，并使用证据决策框架提出建议。
结果：针对五个PICOs，小组就脓毒症患者使用皮质类固醇提出了四项建议，ARDS,和CAP。其中包括有条件的建议对感染性休克患者和危重ARDS患者使用皮质类固醇，以及强烈建议对严重CAP住院患者使用皮质类固醇。该小组还建议不要高剂量/短期使用皮质类固醇治疗感染性休克。为了响应关于ARDS中皮质类固醇分子类型的最终PICO，专家组无法提供针对皮质类固醇分子的具体建议，剂量,和治疗的持续时间，根据现有证据。
结论：专家组根据当前证据提供了最新建议，以告知临床医生，病人,以及使用皮质类固醇治疗脓毒症的其他利益相关者，ARDS,和CAP。
