[Corticosteroids in intensive care medicine]

Area of Science:

• Critical care medicine
• Pharmacology
• Infectious diseases

Background:

• Corticosteroids are increasingly used in critical illnesses, including septic shock, community-acquired pneumonia (CAP), COVID-19, and Acute Respiratory Distress Syndrome (ARDS).
• While some studies suggest benefits, clear guidelines on optimal corticosteroid use are often lacking.
• Specific recommendations vary, with contraindications noted for influenza-associated pneumonia.

Purpose of the Study:

• To review the current evidence and guidelines regarding corticosteroid use in critical illnesses.
• To highlight the benefits observed in specific conditions like septic shock, severe CAP, COVID-19, and ARDS.
• To identify knowledge gaps concerning corticosteroid type, timing, duration, and dosage.

Main Methods:

• Literature review of recent studies and current clinical guidelines.
• Analysis of evidence for corticosteroid efficacy in various critical care settings.
• Identification of unanswered questions in corticosteroid therapy.

Main Results:

• Hydrocortisone and fludrocortisone combination shows promise in septic shock, but lacks guideline support.
• Early corticosteroid therapy is recommended for severe CAP, but not for influenza-associated pneumonia.
• Dexamethasone use in COVID-19 is associated with reduced mortality.
• Corticosteroids are recommended for ARDS, particularly when initiated early.

Conclusions:

• Corticosteroid therapy has demonstrated efficacy in several critical conditions, including septic shock, CAP, COVID-19, and ARDS.
• Significant uncertainties persist regarding optimal corticosteroid selection, treatment timing, duration, and dosage.
• Further research is needed to establish definitive evidence-based guidelines for corticosteroid use in critical care.