ICRounds is a production of the Society of Critical Care Medicine.

This is ICU rounds. My name is Dr. Jeffrey Guy. I'm an associate professor of surgery and director of the burn center at the Vanderbilt University School of Medicine.

Hey everybody, welcome back. I want to talk today about director of the Burns Center at the Vanderbilt University School of Medicine.

Hey, everybody, welcome back. I want to talk today about the topic of adrenal insufficiency or the measurement of cortisol and critically all patients. This is something I see done on a regular

basis. And when you start asking people, what is it that you're doing and why are you doing it?

People are often unable to

give me what I would consider to be a satisfactory answer. So the question becomes, what does a

patient who is adrenal and sufficient look like from a clinical perspective inside the intensive

care unit, who would be clinically hypotensive and resistant to volume resuscitation

and are dependent on the use of vasopressors. Now, there were two studies that were performed in the

1990s that showed the use of stress dose hydrochortizone that they decreased the duration of

vasopressor therapy and improved the overall shock reversal.

And these were the papers done by Ballart and colleagues that were appeared in critical care

medicine back in 1998, volume 26. That was pages 645 to 650, as well as the paper by Briegel and

colleagues that was also in critical care of medicine,

1999, Volume 27, Page of 723 to 732.

Now, in 2002, there was a large multi-center randomized trial that looked at,

did steroids improve patients who had septic shock and who were believed to have renal insufficiency?

And this is classically known as the Anon study. Okay. who had septic shock and who were believed to have renal insufficiency.

And this is classically known as the Anon study.

This was published in JAMA.

And what they determined from that is they defined a relative adrenaline efficiency as an increase in the total cortisol of less than nine in response to a dose of 250 micrograms of

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