Corticosteroids in the ICU Wael Abdel-Moez, MD* w Jaya Kolla, MD z Hesham Omar, MD z} Devanand Mangar, MD z Enrico M. Camporesi, MD w8 University of South Florida, Tampa, Florida ’ Introduction Given the severity of potential side effects, the decision to institute therapy with glucocorticoids in the intensive care unit (ICU) will always require careful consideration of the relative risks and benefits for each patient. For any disease and in any patient, the appropriate dose to achieve a given therapeutic effect must be determined by trial and error and must be reevaluated periodically as the activity of the underlying disease changes or as complications of therapy arise. A single dose of glucocorticoid, even a large one, is virtually without harmful effects, and a short course of therapy (up to 1 wk), in the absence of specific contraindications, is unlikely to be harmful. As the duration of glucocorticoid therapy is increased beyond 1 week, there are time-related and dose-related increases in the incidence of disabling and potentially lethal effects. Except in patients receiving replacement therapy, glucocorticoids are neither specific nor curative; rather, they are palliative by virtue of their anti-inflammatory and INTERNATIONAL ANESTHESIOLOGY CLINICS Volume 47, Number 1, 67–82 r 2009, Lippincott Williams & Wilkins 67 FROM THE *DEPARTMENT OF ANESTHESIOLOGY EGYPTIAN ARMY HOSPITAL; } DEPARTMENT OF CARDIOLOGY UNIVERSITY OF CAIRO, CAIRO, EGYPT; zFLORIDA GULF- TO-BAY ANESTHESIOLOGY GROUP; wDEPARTMENT OF ANESTHESIOLOGY AND CRITICAL CARE MEDICINE AND THE 8DEPARTMENT OF ANESTHESIOLOGY REPRINTS:ENRICO M. CAMPORESI, MD, DEPARTMENT OF ANESTHESIOLOGY ,TAMPA GENERAL HOSPITAL 1, TAMPA GENERAL HOSPITAL CIRCLE,TAMPA 336006, FL, E-MAIL: ECAMPORE@HEALTH.USF .EDU