title: Update on low-dose corticosteroids.
abstract: OBJECTIVE
  Low-dose hydrocortisone is recommended in patients with septic shock unresponsive to fluid and vasopressor therapy. Recent research added new data for patients with septic shock and other target groups such as patients with severe sepsis, acute respiratory distress syndrome (ARDS), community-acquired pneumonia, and burns. The objective of this review is to summarize and comment recent findings on low-dose corticosteroids (LDC) in critically ill patients.
  
  
  RESULTS
  In the last 2 years, a series of clinical trials and retrospective analyses investigated LDC therapy in critically ill patients with severe systemic inflammation of various origins. Improvement in morbidity has been demonstrated in ARDS and community-acquired pneumonia. Retrospective propensity-score analyses also suggest that LDC administered in severe septic shock or in septic shock due to community-acquired pneumonia or intestinal perforation may improve survival.
  
  
  CONCLUSIONS
  Low-dose hydrocortisone or a corresponding low-dose corticosteroid therapy may improve morbidity in specific target groups of critically ill patients. Beneficial effects on mortality remain to be demonstrated in large-scale randomized controlled trials.
authors.affiliation: aKlinik für Anästhesiologie, Klinikum der Universität München, Munich bKlinik für Anästhesiologie, Universitätsklinikum Regensburg, Regensburg, Germany.
authors.forename: Josef
authors.initials: J
authors.lastname: Briegel
authors.forename: Thomas
authors.initials: T
authors.lastname: Bein
authors.forename: Patrick
authors.initials: P
authors.lastname: Möhnle
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002056:Burns / Q000188:drug therapy; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000401:mortality; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D005440:Fluid Therapy; D006801:Humans; D007249:Inflammation / Q000188:drug therapy*; D011014:Pneumonia / Q000188:drug therapy / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D012128:Respiratory Distress Syndrome / Q000188:drug therapy / Q000401:mortality; D018805:Sepsis / Q000401:mortality / Q000628:therapy; D012772:Shock, Septic / Q000401:mortality / Q000628:therapy; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D014662:Vasoconstrictor Agents