title: Do corticosteroids improve outcome for any critical illness?
abstract: OBJECTIVE
  Corticosteroids have been widely administered in critically ill patients for various indications. Their clinical benefit is broadly investigated but remains controversial. The purpose of this review is to explore the use of corticosteroids in intensive care, their impact on patient outcome and to provide practical guidance for the use of corticosteroids in the ICU.
  
  
  RESULTS
  Critical illness is the result of significant tissue damage, due to cellular ischemia, trauma or infection, inducing a systemic inflammatory syndrome. Recent advances in the understanding of the immunologic and molecular mechanisms of inflammation support, in part, the conceptual use of corticosteroids as an adjunct immunomodulatory therapy. But use of corticosteroids carries the risk of severe adverse effects, partly because of their anti-infammatory effects. Recently, clinical research has focused on critical illness-related corticosteroid insufficiency and several trials investigated the role of corticosteroids therapy in septic and critically ill patients with severe systemic inflammation such as acute respiratory distress syndrome, severe community-acquired pneumonia and meningitis. Improved morbidity has been demonstrated in some studies but a clear benefit in term of mortality was not observed.
  
  
  CONCLUSIONS
  Critical illnesses stem from a group of heterogeneous medical conditions. Failure to target subgroups more likely to benefit from the use of corticosteroids may be one explanation for the largely disappointing results in clinical trials, thus, far.
authors: Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors: Baruch M
authors: BM
authors: Batzofin
authors: Yoram G
authors: YG
authors: Weiss
authors: Stephane F
authors: SF
authors: Ledot
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy; D016638:Critical Illness; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000150:complications; D008581:Meningitis / Q000188:drug therapy; D011014:Pneumonia / Q000188:drug therapy; D012128:Respiratory Distress Syndrome / Q000188:drug therapy; D012772:Shock, Septic / Q000188:drug therapy; D013119:Spinal Cord Injuries / Q000188:drug therapy
chemical_list: D000305:Adrenal Cortex Hormones