The Best Use of Systemic Corticosteroids in the Intensive Care Units, Review

Abstract

Corticosteroids are one of the most common medications that are used in the intensive care units (ICUs); corticosteroids are used for a variety of indications, including septic shock, acute respiratory distress syndrome (ARDS), bacterial meningitis, tuberculous meningitis, lupus nephritis, severe chronic obstructive pulmonary disease (COPD) exacerbations and many others. Corticosteroids are associated with many severe side effects that affect morbidity and mortality of the patients like increased risk of infections, glucose intolerance, hypokalemia, sodium retention, edema, hypertension, myopathy etc. In order to make the best use of these medications and to minimize the unwanted side effects we should follow some particular protocol. Please keep in our mind that there is controversy about dosing and tapering of steroids, so effort has been made to include the best available evidence. This review discusses mainly the most common indications of corticosteroids in ICU, dosing of corticosteroids in those indications and how to taper corticosteroids according to the best evidence that recommends their use. Literature search was done using Medline, BMJ, Uptodate, Chochrane database, Google scholar and the best evidence based guidelines in which steroids are recommended to treat ICU related disorders. Sex hormones are not discussed in this review since its use is rare in the intensive care units.