Question special

A 56 year old teacher with a significant history of hypertension and well-controlled diabetes presents to the emergency room (in the U.S.) with a five day history of fever, productive cough, and progressive dyspnea. At presentation he is febrile to 103.2 F, has a blood pressure of 102/66, pulse of 135 beats per minute, respiratory rate of 33/min, and is satting 84% on room air, which improves to 93% on 4L nasal cannula. Labs show a leukocytosis of 18,000, lactate on 1.8, and a bicarbonate of 19 with a gap of 14, and is positive for influenza A. A chest x ray shows a possible left lower lobe infiltrate. He is given 1L of NS, started on ceftriaxone and doxycycline, and is admitted to the medical floor. Overnight he decompensates, with a oxygen desaturation to 72% on 4L, an ABG showing a pH of 7.21 and a PaO2 of 45 mmHg. A rapid response is called and he undergoes RSI with propofol and is transferred to the MICU. His blood pressure is now 70/42 mmHg with a MAP of 51. He is given a 2L bolus of NS without a significant hemodynamic response. A central line is placed and the repeat chest x ray shows worsening bilateral opacities. Antibiotics are broadened to vancomycin plus piperacillin/tazobactam and norepinephrine has been titrated up to a rate of 24 ug/minute. Repeat labs show a rising creatinine at 3.1 mg/dL, a troponin T of 1.2 ng/mL, and a lactate of 5.2 mmol/L.

It’s been 7 hours since pressors were initiated, at this point, would you or would you not administer corticosteroids? If so, at what dose, administration, and duration?