[Glucocorticoids in multiple trauma and infection--still a topic for discussion?]

The clinical use of glucocorticoids in trauma and sepsis has not yet been approved on the basis of clinical trials. Current knowledge in the area of pathogenesis is reviewed, and against this background the mechanisms of steroid action will be discussed, the current status of clinical testing in both trauma and sepsis will be evaluated, and ways of testing the effectiveness will be proposed. Although most trials up to now have shown a positive overall effect in trauma patients, a further prospective randomized controlled study with a more homogeneous study population and including trauma scores is necessary before trauma can be reliably accepted as a firm indication for glucocorticoid treatment. In the discussion on sepsis syndrome a variety of reasons are suggested for the failure of earlier studies to show beneficial effects. Besides methodological aspects, one of the main reasons is the neglected field of pharmacologic-pharmacokinetic principles. A new study should be performed under therapeutic drug-monitoring (TDM) conditions once more is known about the target concentration range.