Hi, everyone. Thanks for joining us today. My name is Dipayan Chaudhary. I'm an intensivist based out of McMaster University in Hamilton, Canada, and I'll be presenting the first part of our 2024 Focused Update Guidelines on Use of Corticosteroids and Sepsis, ARDS, and Chlamydia-Acquired Pneumonia on behalf of our guideline panel. I have no academic or financial conflicts of interest to disclose. So I'll start off with a bit of background. So this all started first in 2008 with a consensus statement released by the American College of Critical Care Medicine. This was a 16-panelist consensus statement based out of intensivists and endocrinologists, and they made 12 recommendations on the diagnosis and management of critical illness-related corticosteroid insufficiency. A modified Delphi methodology was used to achieve consensus. No clear PICOs were established for this statement, and a general literature review rather than a comprehensive systematic review was conducted for each recommendation. Finally, a modified grade system was used to quantify the strength of the recommendations. This was then updated in 2017 with a joint guideline released by the SCCM and ESICM. This was, again, a 16-panelist guideline comprised of members of SCCM as well as ESICM. It updated the diagnosis of corticosteroid insufficiency-related critical illness and discussed the management of eight important clinical conditions. This included not just sepsis, ARDS, and community-acquired pneumonia, but also things like trauma, post-cardiac surgery, as well as cardiac arrest. This updated guideline used a rigorous application of grade methodology with clearly defined PICOs with patient-important outcomes, a comprehensive systematic review for each PICO, as well as a consistent framework used for making recommendations from the evidence. However, since 2017, there have been multiple sort of seminal trials released on the management of corticosteroids and critical illness, particularly in the areas of septic shock, ARDS, particularly COVID ARDS, as well as community-acquired pneumonia. So that led us to conduct this 2024 focused update, focusing specifically on sepsis, ARDS, and community- acquired pneumonia. These conditions were picked because they were the most common diagnosis in which corticosteroids are considered and in which there is sufficient new data. We did not reassess the definition and diagnosis of CIRCI, and we used an updated grade methodology with a more rigorous evidence of decision-making framework to conduct these guidelines. We established a 22-member panel consisting of two endocrinologists and 20 critical care practitioners, of which 20 were voting members. Two did not vote because of conflict of interest. We had a guideline leadership group consisting of two chairs and two co-vice chairs, as well as a four-member methodology team. We came up with five PICO questions. The first one was, should corticosteroids be administered to hospitalized patients with sepsis? The second was, if patients with sepsis are administered corticosteroids, should high-dose short-duration be used over low-dose long-duration? The third was, should corticosteroids compared to no corticosteroids be used in patients with ARDS? Should methylprednisone be used over corticosteroids in patients with ARDS? And should corticosteroids be administered to hospitalized patients with community-acquired pneumonia? Once we had come up with these PICO questions, we polled the guideline panel and came up with a list of outcomes that we thought would be important to assess to address these PICO questions. And then we asked them to rank each outcome from a scale of 1 to 9, with 9 being the most important and 1 being the least important. We averaged out all the ratings from all the guideline panel members, and then we ranked the outcomes in terms of importance as a result. Then we conducted systematic reviews on our PICO questions. We used previous reviews that were done by members of the guideline panels as a springboard to move ahead. We conducted a standard systematic review and meta-analysis protocol using a professional librarian to create an updated search strategy. We dual-extracted our data and pooled and meta-analyzed everything, and then we analyzed our other studies for risk of bias. We use this to then generate evidence profiles, which presents a summary of our findings, which were essentially our effect sizes, both relative and absolute, as well as the certainty or the quality of the evidence we generated. Here you can see some examples of what an evidence profile would look like for each individual outcome that we tested for each individual PICO. Once we had generated our evidence profiles, we met together as a guideline panel and considered not just the quality of the evidence and the evidence profile, but also the costs of the interventions we were looking at, patient values and preferences, as well as healthcare provider values and preferences, the risk and benefits of the intervention, its feasibility, as well as equity, to come together and make a recommendation. Thank you.

corticosteroid guidelines

sepsis

ARDS

community-acquired pneumonia

systematic review