Acute and Critical Care

Review Articles

Basic science and research
Critical illness-related corticosteroid insufficiency: latest pathophysiology and management guidelines: Fremita Chelsea Fredrick, Anish Kumar Reddy Meda, Bhupinder Singh, Rohit Jain; Acute Crit Care. 2024;39(3):331-340. Published online August 30, 2024; DOI: https://doi.org/10.4266/acc.2024.00647

51,590 View
2,762 Download
8 Web of Science
10 Crossref

Intensive care unit (ICU) admissions in the United States exceed 5.7 million annually, often leading to complications such as post-intensive care syndrome and high mortality rates. Among these challenges, critical illness-related corticosteroid insufficiency (CIRCI) requires emphasis due to its complex, multiple-cause pathophysiology and varied presentations. CIRCI, characterized by adrenal insufficiency during critical illness, presents in up to 30% of ICU patients and may manifest as an exaggerated inflammatory response. Factors such as dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, altered cortisol metabolism, tissue corticosteroid resistance, and drug-induced suppression contribute to CIRCI. Diagnosis is a complex process, relying on a comprehensive assessment including clinical presentation, laboratory findings, and dynamic stimulatory testing. Treatment involves intensive medical care and exacting glucocorticoid therapy. Recent guidelines advocate for individualized approaches tailored to patient presentation and etiology. Understanding the pathophysiology and treatment of CIRCI is vital for clinicians managing critically ill patients and striving to improve outcomes. This research paper aims to explore the latest developments in the pathophysiology and management of CIRCI.

Citations

Citations to this article as recorded by

Sepsis-associated encephalopathy: Unraveling molecular mechanisms, emerging therapeutics, and translational frontiers
Xinlong Zhang, Kaizong Huang, Zixin Wu, Rui Ding, Junming Han, Yuan Zhang, Yaping Lu, Yingmei Lu, Yanna Si
Pharmacology & Therapeutics.2026; 278: 108971. CrossRef
Brain-Region-Mediated Neuroimmune Modulation in Sepsis: Research Advances and Therapeutic Prospects
Xuechun Zhou, Ying Tang, Hui Chen, Wei Huang, Haibo Qiu
Journal of Inflammation Research.2026; Volume 19: 1. CrossRef
Higher Serum Cortisol is Associated with Delayed Shock Resolution in Septic Shock Patients
Sophon Dumrongsukit, Suranut Charoensri, Kamonwan Mulalin, Anupol Panitchote
Journal of Intensive Care Medicine.2026;[Epub] CrossRef
Trajectories of mean arterial pressure/norepinephrine equivalent dose index in patients with septic shock receiving low-dose hydrocortisone: a retrospective cohort study in Thailand
Auttawut Chalermwutanon, Sawangjit Saejaow, Veerapong Vattanavanit
Acute and Critical Care.2026; 41(1): 107. CrossRef
Neuroendocrine Balance Index: an Indicator of Metabolic Response to Surgical Stress in Cardiac Surgery
Lada O. Sobanska, Volodymyr I. Cherniy
Ukrainian Journal of Cardiovascular Surgery.2026; 34(1): 119. CrossRef
Physiological Influence of Licorice Extract on Some Hormonal and Biochemical Parameters Alterations Induced by Glucocorticoid in Male Rats
Sohier Syame, Safinaz Badie
Ricos Biology.2025; 3(2): 19. CrossRef
Adrenal Insufficiency After Glucocorticoid Use in the Pediatric Intensive Care Unit
Ashley N. Radig, Vanessa A. Curtis, Erik Westlund, Christina L. Cifra
Journal of Intensive Care Medicine.2025; 40(12): 1285. CrossRef
Recognizing and managing critical illness-related corticosteroid insufficiency in pediatric critical care
Ja Hye Kim
Archives of Pediatric Critical Care.2025; 3(1): 14. CrossRef
A consensus blood transcriptomic framework for sepsis
Brendon P. Scicluna, Kiki Cano-Gamez, Katie L. Burnham, Emma E. Davenport, Andrew Reese Moore, Soumen Khan, Charles J. Hinds, Olaf L. Cremer, Purvesh Khatri, Timothy E. Sweeney, Julian C. Knight, Tom van der Poll
Nature Medicine.2025; 31(12): 4119. CrossRef
Cortisol Testing in Septic Shock: An Evaluation of Diagnostic Performance and Predictors of Corticosteroid Use in a Middle Eastern Cohort
Fayez Alshamsi, Saeed Alkaabi, Maryam Nasser Mohamedali Alfadli, Naser Abdulla Naser Salem Alshkeili, Sultan Majed Ibrahim Alhosani, Adnan Agha
Diagnostics.2025; 15(20): 2588. CrossRef

Pulmonary
Beyond survival: understanding post-intensive care syndrome: Lovish Gupta, Maazen Naduthra Subair, Jaskaran Munjal, Bhupinder Singh, Vasu Bansal, Vasu Gupta, Rohit Jain; Acute Crit Care. 2024;39(2):226-233. Published online May 24, 2024; DOI: https://doi.org/10.4266/acc.2023.01158

27,665 View
955 Download
20 Web of Science
21 Crossref

Abstract PDF

Post-intensive care syndrome (PICS) refers to persistent or new onset physical, mental, and neurocognitive complications that can occur following a stay in the intensive care unit. PICS encompasses muscle weakness; neuropathy; cognitive deficits including memory, executive, and attention impairments; post-traumatic stress disorder; and other mood disorders. PICS can last long after hospital admission and can cause significant physical, emotional, and financial stress for patients and their families. Several modifiable risk factors, such as duration of sepsis, delirium, and mechanical ventilation, are associated with PICS. However, due to limited awareness about PICS, these factors are often overlooked. The objective of this paper is to highlight the pathophysiology, clinical features, diagnostic methods, and available preventive and treatment options for PICS.

Citations

Citations to this article as recorded by

Bodily and Cognitive Experience in Patients With Sepsis and Delirium or Subsyndromal Delirium
Evelyn Álvarez Espinoza, Natalia Castillo‐Núñez, Pablo Olivares Araya, Renata Francisca Olate Barnech, Valentina Vallejos Salfate
Nursing in Critical Care.2026;[Epub] CrossRef
Post–intensive care syndrome: From diagnosis to treatment
Claudia Denke, Karin Steinecke, Henning Krampe, Désirée J. Boehnke, Björn Weiß, Claudia Spies
Deutsches Ärzteblatt international.2026;[Epub] CrossRef
Post‐intensive care syndrome after critical illness: incidence and predictors in a nationwide cohort
Tak Kyu Oh, In‐Ae Song
Anaesthesia.2026;[Epub] CrossRef
A care transition measure for post-intensive care syndrome (PICS) survivors following cardiac surgery: a commentary
Monica Parry
European Journal of Cardiovascular Nursing.2026;[Epub] CrossRef
Assessing Caregiver Needs of Critically-lll Children With Noncancer Diagnoses: A Qualitative Study
Christina Tempesta, Erika Abramson, Jennifer A. Salant
Journal of Pain and Symptom Management.2026;[Epub] CrossRef
Post-intensive Care Syndrome (PICS): an American Association for the Surgery of Trauma Critical Care Committee Consensus Guideline – Defining, Recognizing, and Managing PICS Associated Physical Impairment, Cognitive Dysfunction, and Thromboinflammatory Dy
Jeffrey Anderson, Eden A Nohra, Anna Liveris, Rachel Appelbaum, Asanthi Ratnasekera, Ruben Peralta, Jason Young, Jordan Michael Kirsch, Randeep Jawa, Susan McLean, Bryce Robinson, Joseph Cuschieri
Trauma Surgery & Acute Care Open.2026; 11(2): e002172. CrossRef
Dyspnoe bei invasiv beatmeten Patientinnen und Patienten: eine Übersicht
Benjamin Neetz, Philipp Höger, Franziska Kaestner, Felix Herth, Franziska Trudzinski
Pneumologie.2026;[Epub] CrossRef
Post-COVID microvascular dysfunction in hospitalized COVID-19 survivors is associated with acute disease severity and persistent cognitive complaints
Noa van der Knaap, Simona Klinkhammer, Alida A. Postma, Johanna M.A. Visser-Meily, Janneke Horn, Caroline M. van Heugten, Paulien H.M. Voorter, Merel M. van der Thiel, Gerhard S. Drenthen, Walter H. Backes, Frank van Rosmalen, Susanne van Santen, Bas C.T.
Journal of the Neurological Sciences.2025; 472: 123464. CrossRef
Comparing virtual reality with traditional methods in cognitive rehabilitation in PICS syndrome
A. Despoti, I. Patsaki, A. Alexandropoulou, E. Magkouti, D. Tzoumi, N. Leventakis, G. Roussou, Α. Papathanasiou, N. Dimitriadi, P. Presvelou, S. Nanas, E. Karatzanos
Applied Neuropsychology: Adult.2025; : 1. CrossRef
Prevalence of Post-intensive care syndrome among intensive care unit-survivors and its association with intensive care unit length of stay: Systematic review and meta-analysis
Temesgen Ayenew, Menberu Gete, Mihretie Gedfew, Addisu Getie, Abebe Dilie Afenigus, Afework Edmealem, Haile Amha, Girma Alem, Bekele Getenet Tiruneh, Mengistu Abebe Messelu, Ramya Iyadurai
PLOS One.2025; 20(5): e0323311. CrossRef
Acute stress disorder in patients with traumatic spinal cord injury: risk factors and coping strategies
Haohua Shi, Yufang Su, Chunyan Pan
Frontiers in Psychiatry.2025;[Epub] CrossRef
Supporting Post-ICU Recovery: A Narrative Review for General Practitioners
Charikleia S. Vrettou, Athina G. Mantelou
Diseases.2025; 13(6): 183. CrossRef
Delirium as a Precursor to Postintensive Care Syndrome
Jenna Woodford
Physician Assistant Clinics.2025; 10(4): 729. CrossRef
The effects of restricted visitation on delirium incidence in the intensive care units of a tertiary hospital in South Korea
Leerang Lim, Christine Kang, Minseob Kim, Jinwoo Lee, Hong Yeul Lee, Seung-Young Oh, Ho Geol Ryu, Hannah Lee
Acute and Critical Care.2025; 40(3): 452. CrossRef
The Mediating Effects of Sleep Quality and Fatigue on Post‐Intensive Care Syndrome Among Intensive Care Unit Survivors
Hui‐Fang Yeh, Tzu‐Yu Tseng, Ling‐Hua Wang, Chia‐Lun Lo, Jun‐Yih Chen, Hui‐Ju Cheng, Yu‐Hua Lin
International Journal of Nursing Practice.2025;[Epub] CrossRef
Factors Associated with Post-Intensive Care Syndrome in Patients Attending a Hospital in Northern Colombia: A Quantitative and Correlational Study
Jorge Luis Herrera Herrera, Yolima Judith Llorente Pérez, Edinson Oyola López, Gustavo Edgardo Jiménez Hernández
Nursing Reports.2025; 15(9): 311. CrossRef
Sleep Quality Assessment in Intensive Care Units: Comparing Actigraphy and the Richards Campbell Sleep Questionnaire—A Pilot Study in the Moroccan Context
Abdelmajid Lkoul, Keltouma Oumbarek, Youssef Bouchriti, Asmaa Jniene, Tarek Dendane
Clocks & Sleep.2025; 7(3): 49. CrossRef
Predictors of Post-Intensive Care Syndrome in ICU Survivors After Discharge: An Observational Study
Francesco Gravante, Paolo Iovino, Francesca Trotta, Beatrice Meucci, Marco Abagnale, Stefano Bambi, Gianluca Pucciarelli
Journal of Clinical Medicine.2025; 14(17): 6043. CrossRef
From Resuscitation to Rehabilitation: The Post-Intensive Care Syndrome Continuum in Sepsis Care
Matthew Sherman, Perry Lim, Tariq Cheema, Briana DiSilvio, Perry Tiberio
Journal of Clinical Medicine.2025; 14(23): 8374. CrossRef
Supplementation with GPR120 (Ffar4) ligand omega-3 does not improve survival in murine sepsis models
Susana Castelo Branco Ramos Nakandakari, Eric Isaac Elliott, Renan Fudoli Lins Vieira, Thaiane da Silva Rios, Andin Fosam, Isadora Carolina Betim Pavan, Maíra Maftoum Costa, Luiz Guilherme Salvino da Silva, Camila de Oliveira Ramos, Giovana Rios Gonçalves
American Journal of Physiology-Endocrinology and Metabolism.2025; 329(5): E663. CrossRef
“Lost in Transition”: Informational Needs of Sepsis Survivors and Their Relatives Across the Care Trajectory—A Qualitative Study
Frank Vahl, Susanne Ullmann, Lea Draeger, Lena Kannengießer, Mathias W. Pletz, Claudia T. Matthaeus-Kraemer, Carolin Fleischmann-Struzek
Journal of Clinical Medicine.2025; 15(1): 91. CrossRef

First
Prev
Page of 1
Next
Last

Search