Glucocorticoids (GC) in all its various forms and formulations are likely one of the most commonly used pharmacologic agents in medicine. Their use can be profoundly therapeutic but are also associated with a myriad of acute and chronic side effects. It is fairly well-accepted in the medical community that GC can be life-saving when used in critically ill patients with severe exacerbations of asthma and chronic obstructive pulmonary disease, HIV-associated pneumocystosis, and systemic vasculitides. However, the adjunctive role of GC is much more controversial in acute respiratory distress syndrome (ARDS), septic shock, community-acquired pneumonia, and several other serious medical conditions. Despite such controversies, GC should at least be considered for patients with fulminant manifestations of the following conditions as there is equipoise to indicate that GC may improve outcome with acceptable risks: (i) severe ARDS with refractory hypoxemia despite one to two weeks of state-of-the-art management, (ii) recalcitrant, vasopressor-dependent septic shock, (iii) non-influenza, severe community-acquired pneumonia, and (iv) severe alcoholic hepatitis. The bases for these controversies is likely due to both host factors (e.g., differences in GC resistance and susceptibility to adverse effects) and different phenotypes of any one disease state; e.g., different pathogenesis and pathogens under the rubric of "sepsis." Elucidation of better biomarkers to determine the underlying pathogenic phenotype will significantly advance our understanding and prediction of which critically ill patients will benefit from GC and who would experience a deleterious effect from its use.

中文翻译：

---

在重症监护环境中使用糖皮质激素：科学和临床证据。

各种形式和制剂的糖皮质激素（GC）可能是医学上最常用的药物之一。它们的使用可能具有深远的治疗意义，但也与多种急性和慢性副作用有关。在患有严重加重哮喘和慢性阻塞性肺病，HIV相关性肺囊肿和全身性血管炎的重症患者中，GC可以挽救生命，这在医学界已广为接受。然而，在急性呼吸窘迫综合征（ARDS），败血性休克，社区获得性肺炎和其他几种严重的医学疾病中，GC的辅助作用争议更大。尽管存在此类争议，具有以下情况的暴发性表现的患者至少应考虑使用GC，因为有足够的平衡表明，GC可以改善具有可接受风险的预后：（i）严重的ARDS伴有难治性低氧血症，尽管病情持续了一到两周艺术管理，（ii）顽固性，依赖升压药的败血性休克，（iii）非流感，严重的社区获得性肺炎，以及（iv）严重的酒精性肝炎。这些争议的基础可能是由于宿主因素（例如，GC耐药性的差异和对​​不良反应的敏感性）以及任何一种疾病状态的不同表型所致。例如，在“败血症”的标题下存在不同的发病机制和病原体。