Machiavelli once said, “Anyone wishing to see what is to be must consider what has been.”1 For nearly 40 years, enthusiasm for steroid use in the intensive care unit (ICU) has been like a pendulum, cyclically swinging toward and then away from their use. Currently, enthusiasm for steroid use appears to be on an upswing. Despite decades of conflicting data, steroids are once again being advocated for the treatment of sepsis. In addition, with a greater appreciation for the prevalence of “relative” adrenal insufficiency in the ICU, the use of steroids appears to be increasing. A historical review of the subject would lead one to proceed down this path with caution.
Rotondo MF, Schenarts PJ. Corticosteroid Use in the Intensive Care Unit: At What Cost?—Invited Critique. Arch Surg. 2006;141(2):149. doi:10.1001/archsurg.141.2.149