Corticosteroids are frequently administered to critically ill patients due to their beneficial effects on pro-inflammatory cytokines and the cardiovascular system. Common indications include infective exacerbation of asthma and chronic obstructive pulmonary disease (COPD), severe COVID-19 infection, anaphylaxis, laryngeal oedema, refractory septic shock, community-acquired pneumonia (CAP) and acute respiratory distress syndrome. Recent guidelines from the Society of Critical Care Medicine have varying levels of recommendations, with strong recommendations for corticosteroid use for thetreatment of severe bacterial CAP and septic shock.

The role of corticosteroids in critically ill patients remains controversial. Despite its postulated benefits, they have significant side effects including hyperglycaemia, secondary infections, neuromuscular weakness, delirium and gastrointestinal ulcers or bleeds. Furthermore, there is an association between increased long-term cumulative steroid dose (>1000 mg prednisolone-equivalent) and the development of acute and chronic complications such as avascular necrosis.