 |
|
Corticosteroid Use in the Intensive Care Unit
At What Cost?
Rebecca C. Britt, MD;
Alicia Devine, MD;
Karen C. Swallen, PhD;
Leonard J. Weireter, MD;
Jay N. Collins, MD;
Frederic J. Cole, MD;
L. D. Britt, MD, MPH
Arch Surg. 2006;141:145-149.
Hypothesis Corticosteroid use has a significant effect on morbidity and mortality in the intensive care unit (ICU).
Design Case-control study.
Setting Burn-trauma ICU in a level 1 trauma center.
Patients All patients who received corticosteroids while in the ICU from January 1, 2002, to December 31, 2003 (n = 100), matched by age and Injury Severity Score with a control group (n = 100).
Interventions None.
Main Outcome Measures We considered the following 7 outcomes: pneumonia, bloodstream infection, urinary tract infection, other infections, ICU length of stay (LOS), ventilator LOS, and mortality.
Results Cases and controls had similar APACHE II (Acute Physiology and Chronic Health Evaluation II) scores and medical history. In univariate analysis, the corticosteroid group had a significant increase in pneumonia (26% vs 12%; P<.01), bloodstream infection (19% vs 7%; P<.01), and urinary tract infection (17% vs 8%; P<.05). In multivariate models, corticosteroid use was associated with an increased rate of pneumonia (odds ratio [OR], 2.64; 95% confidence interval [CI], 1.21-5.75) and bloodstream infection (OR, 3.25; 95% CI, 1.26-8.37). There was a trend toward increased urinary tract infection (OR, 2.31; 95% CI, 0.94-5.69), other infections (OR, 2.57; 95% CI, 0.87-7.67), and mortality (OR, 1.89; 95% CI, 0.81-4.40). Patients in the ICU who received corticosteroids had a longer ICU LOS by 7 days (P<.01) and longer ventilator LOS by 5 days (P<.01).
Conclusions Corticosteroid use is associated with increased rate of infection, increased ICU and ventilator LOS, and a trend toward increased mortality. Caution must be taken to carefully consider the indications, risks, and benefits of corticosteroids when deciding on their use.
Author Affiliations: Departments of Surgery (Drs R. C. Britt, Weireter, Collins, Cole, and L. D. Britt) and Emergency Medicine (Dr Devine), Eastern Virginia Medical School, Norfolk; and Center for Demography and Ecology, University of Wisconsin, Madison (Dr Swallen).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati
What's this?
RELATED LETTERS
Corticosteroids in Critically Ill Patients: A Long and Winding Road
Jorge Ibrain Figueira Salluh and Anna Gabriela Fuks
Arch Surg. 2006;141(9):945.
EXTRACT
| FULL TEXT
Steroids and the Intensive Care Unit
William H. Marx
Arch Surg. 2006;141(9):945-946.
EXTRACT
| FULL TEXT
Using Corticosteroids in Intensive Care
Paul E. Marik, Djillali Annane, Charles L. Sprung, Wiebke Arlt, Didier Keh, and for the International Task Force on the Diagnoses and Management of Adrenal Insufficiency in the Critically Ill
Arch Surg. 2006;141(9):946-947.
EXTRACT
| FULL TEXT
Using Corticosteroids in Intensive Care—Reply
Rebecca C. Britt
Arch Surg. 2006;141(9):947.
EXTRACT
| FULL TEXT
RELATED ARTICLE
Corticosteroid Use in the Intensive Care Unit: At What Cost?—Invited Critique
Michael F. Rotondo and Paul J. Schenarts
Arch Surg. 2006;141(2):149.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Modulation of glucocorticoid receptor expression, inflammation, and cell apoptosis in septic guinea pig lungs using methylprednisolone
Kamiyama et al.
Am. J. Physiol. Lung Cell. Mol. Physiol. 2008;295:L998-L1006.
ABSTRACT
| FULL TEXT
Adrenal Insufficiency in Critical Illness
Cooper and Stewart
J Intensive Care Med 2007;22:348-362.
ABSTRACT
Corticosteroids in Critically Ill Patients: A Long and Winding Road
Salluh and Fuks
Arch Surg 2006;141:945-945.
FULL TEXT
Using Corticosteroids in Intensive Care
Marik et al.
Arch Surg 2006;141:946-947.
FULL TEXT
Steroids and the Intensive Care Unit
Marx
Arch Surg 2006;141:945-946.
FULL TEXT
|
