Steroids. I always have mixed feelings about them. It’s a Love & Hate relationship inside my head. On one hand I cannot stand those who claim steroids are the critical care’s Holy Grail. Steroids for sepsis, ARDS, trauma, anemia, bleeding, extubation failure, cold, hair loss, seizure, meningitis, stroke, heart failure, stinky farts and so on… We all know at least one of these bastards! On the other hand, I feel a warm feeling in my heart when I give steroids in some selected cases: maybe septic shock, some post extubation stridor, maybe meningitis…and sometimes pneumonia. During my residency training there was a “wing” (let’s call it a wing instead of gang) of doctors (mostly pneumologists) who strongly defended the use of steroids as an adjunctive treatment in severe pneumonia, while the other “wing” (intensivists, and myself included) had more important things to do and didn’t give a damn about their opinions.

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