Sepsis, N/IICU — Steroids — Clinical Pathway: ICU and Inpatient

Suspected Sepsis Clinical Pathway — N/IICU

Steroids

Considerations for Chronic Steroids and Adrenal Insufficiency

If patient has recent steroid exposure, has been on steroids > 2 wks, or has concerns for adrenal insufficiency, consider hydrocortisone dosing based on the Pathway for Child at Risk of HPA Suppression.

Hydrocortisone Indications

  • Persistently hypotensive despite adequate fluid resuscitation and titration of one pressor infusion (typically dopamine up to 10-15 mcg/kg/min)
  • Hydrocortisone dosing recommendation for management of persistent hypotension (in the absence of chronic steroid exposure and adrenal insufficiency):
    • Hydrocortisone 1 mg/kg/dose IV q6
    • Assess for response
    • Not all babies with severe sepsis will respond to steroids
      • If, at any point in course, there is no response, consider discontinuing steroids

Considerations for Discontinuing Hydrocortisone

  • If patient still on hydrocortisone when pressor infusions no longer required, ensure that plan for weaning off hydrocortisone is discussed daily until off
  • If prolonged steroid exposure (> 2 wks)