Statins in critical care: to give or not to give?

Owing to their immune modulatory, anti-inflammatory, antioxidant, antithrombotic, and endothelial action, statins are widely used in the critical care setting in several disease scenarios. The present review focuses on the evidence supporting an even wider utilization of statins in intensive care practice for diverse indications. A search of the literature was carried out in PubMed, Cochrane and EMBASE databases up to January 2016. Review articles, meta-analyses, and original trials on the effects of statin therapy in the intensive care unit (ICU) were included, by combining the following MeSH terms: "statins," "intensive care," "cardiac surgery," "sepsis," "acute respiratory distress syndrome," "pneumonia," "subarachnoid hemorrhage," "traumatic brain injury," and "critical illness." Case reports were excluded. No language restriction was applied. References were also searched for other potentially useful articles. It was concluded that beneficial effects of statins are observed in cardiac surgery; however, no robust evidence supports their effectiveness in diverse critical care settings. The decision to discontinue statins in native users should be taken in consideration of particular clinical circumstances.