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.
Marx WH. Steroids and the Intensive Care Unit. Arch Surg. 2006;141(9):945-946. doi:10.1001/archsurg.141.9.945-b