Indications and practical use of replacement dose of corticosteroids in critical illness.
OBJECTIVE
Ongoing and severe systemic inflammation affecting critically ill patients may cause adrenal insufficiency and steroid resistance in target cells. As the appropriate diagnosis of this clinical entity remains a challenge, indication and practical use of corticosteroid replacement therapy in the critically ill is generally directed by clinical symptoms and features.


RESULTS
In the last 2 years, a series of clinical trials have been undertaken to investigate corticosteroid replacement therapy in critically ill patients with severe systemic inflammation of various origin. Improvements of morbidity have been demonstrated in some studies. The data of recent studies should lead to a restriction of corticosteroid replacement therapy in critically ill patients. The purpose of this review is to investigate indications and the best current practical use of corticosteroid replacement therapy in critically ill patients in the absence of accurate laboratory assessment of adrenal insufficiency.


CONCLUSIONS
Corticosteroid replacement therapy may improve morbidity and mortality in specific target groups of critically ill patients. The appropriate target groups remain to be refined. To demonstrate this, additional studies are required on endocrine disorder in critical illness and corticosteroid replacement therapy.
Briegel
Josef
J
Department of Anaesthesiology, University Hospital, Ludwig-Maximilians University, Munich, Germany. josef.briegel@med.uni-muenchen.de
Kilger
Erich
E
Schelling
Gustav
G
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000627:therapeutic use; D000309:Adrenal Insufficiency; D016638:Critical Illness / Q000628:therapy*; D005858:Germany; D020249:Hormone Replacement Therapy; D006801:Humans; D018746:Systemic Inflammatory Response Syndrome / Q000188:drug therapy / Q000276:immunology
D000305:Adrenal Cortex Hormones