Corticosteroids in the Critically Ill Patient

Corticosteroids are among the most commonly prescribed medications. Because of their wide use and vast influence on various aspects of homeostasis, it is not surprising that steroids may be beneficial in some clinical scenarios and deleterious in others. The interplay between nosocomial pneumonias and steroids represents one of the most remarkable intersections between a drug and a disease. Corticosteroids may influence the risk of a hospitalized patient developing pneumonia, but they may ultimately be necessary if a patient develops catecholamine-resistant septic shock or if overt bronchospasm is present. In addition, prolonged inappropriate use of corticosteroids is likely to increase negative side effects (including myopathy) and decrease the immediate benefit received from the medication. In this review, we provide an overview of corticosteroid physiology and side effects, followed by indications for their use and their epidemiology of use in the intensive care unit. Finally, we discuss their impact on the development and outcomes of nosocomial pneumonia.