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Corticosteroids in the Critically Ill Patient

Benefits and Risks for Hospital-acquired Pneumonia/Ventilator-associated Pneumonia

Ranzani, Otavio T. MD*,†,‡; Zampieri, Fernando G. MD§; Caruso, Pedro MD, PhD*; Torres, Antoni MD, PhD, FERS†,∥

doi: 10.1097/CPM.0000000000000102
Critical Care/Respiratory Care

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.

*Respiratory Intensive Care Unit, Pulmonary Division, Heart Institute, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo

Amil Critical Care Group, Intensive Care Department, Hospital Paulistano

§Intensive Care Unit, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil

Servei de Pneumologia, Institut del Torax, Hospital Clinic, IDIBAPS, Universitat de Barcelona

Centro de Investigación Biomedica En Red-Enfermedades Respiratorias, CibeRes, Barcelona, Spain

Disclosure: The authors declare that they have no conflicts of interest.

Address correspondence to: Otavio T. Ranzani, MD, LIM/09, Laboratorio de Pneumologia Faculdade de Medicina da USP, Av. Dr. Arnaldo, 455 Laboratório de Pneumologia, 2° andar, Sala 2144, Cerqueira César, Sao Paulo, SP 01246903, Brasil. E-mail:

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