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Britt et al¹ have raised interesting points about the use of steroids in the trauma intensive care unit; however, their conclusions are in opposition to practice in the intensive care setting. Wengrovitz et al² have demonstrated an increased incidence of infections on regression analysis with chronic steroid use, pedal pulses, and ipsilateral ulceration. The National Acute Spinal Cord Injury Study,³ a prospective, randomized trial of spinal cord injury and steroid use, showed that mortality due to respiratory complications, severe pneumonia, and sepsis was not statistically significant. The study was underpowered for determination of infectious complications.

A search of the Cochrane Reviews shows there are no articles for steroids and postoperative complications. The Centers for Disease Control and Prevention were unable to definitely recommend the cessation of steroids before surgery to reduce infectious complications.⁴ The study by Annane et al⁵ is a placebo-controlled, randomized, double-blind study of mortality in patients with . . . [Full Text of this Article]

AUTHOR INFORMATION
William H. Marx, DO

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