---
title: "Corticosteroid Therapy in Pneumonia and Critical Illness: Agent Selection, Dosing, Monitoring, Int"
id: "pubmed-42638128"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42638128"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42638128/"
doi: "10.1186/s41479-026-00209-y"
published_at: "2026-08-25T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Corticosteroid Therapy in Pneumonia and Critical Illness: Agent Selection, Dosing, Monitoring, Int
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42638128
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42638128/)
- **DOI:** [10.1186/s41479-026-00209-y](https://doi.org/10.1186%2Fs41479-026-00209-y)
- **Published At:** 2026-08-25T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This review provides a practical, evidence-based guide for **corticosteroid therapy** in adults with severe pneumonia, ARDS, and septic shock encountered in the ICU. It emphasizes syndrome-specific decision-making rather than a one-size-fits-all approach. - The authors define a clear target audience: intensivists, pulmonologists, infectious disease specialists, and critical care pharmacists, and focus on bedside applicability. - Six clinical pillars frame the guidance: (1) pathophysiology of **critical illness-related corticosteroid insufficiency (CIRCI)**; (2) syndrome-specific agent selection informed by landmark trials; (3) dosing, administration, and tapering strategies; (4) structured safety monitoring; (5) management of high-risk drug–drug interactions; and (6) comparative efficacy across agents. - The review synthesizes evidence from major trials and sources including **CAPE COD**, **RECOVERY**, **DEXA-ARDS**, **APROCCHSS**, **ADRENAL**, and the 2024 SCCM/ESICM focused guidelines to produce practical recommendations and algorithms. - Important pathogen-specific distinctions are highlighted: benefit of corticosteroids in **COVID-19** versus demonstrated harm in **influenza**; these differences impact agent selection and indication. - The article underscores that immunocompromised patients were systematically excluded from landmark trials; dedicated discussion addresses the special challenges and considerations for this group. - The authors provide practical implementation tools: algorithms, monitoring tables, and drug interaction checklists intended to support real-time clinical decision-making at the bedside. - Conflict of interest and ethics statements: no competing interests declared; ethics approval not required for this review. The authors used an AI language model for text refinement but retain responsibility for content. - Where granular numeric details (for example, specific dosing regimens or monitoring thresholds) are not listed in the abstract, the review claims to address them in the full text; the abstract does not report those precise details.
## Clinical Analysis & Structured Key Points
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Sara.sm.68@gmail.com.") Affiliations Expand ### Affiliations * 1 Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. * 2 Department of Internal Medicine, School of Medicine, Vali-e-Asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran. * 3 Department of Infectious Diseases and Tropical Medicine, Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. mnakhostin@gmail.com. * 4 Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Sara.sm.68@gmail.com. * PMID: **42638128** * DOI: [ 10.1186/s41479-026-00209-y ](https://doi.org/10.1186/s41479-026-00209-y) Item in Clipboard Review # A clinician's guide to corticosteroid therapy in pneumonia and critical illness: agent selection, dosing, monitoring, and interactions Niloofar Khoshnam Rad et al. Pneumonia (Nathan). 2026. Show details Display options Display options Format Abstract PubMed PMID Pneumonia (Nathan) Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Pneumonia+%28Nathan%29%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Pneumonia+%28Nathan%29%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42638128/) . 2026 Aug 25;18(1):19. doi: 10.1186/s41479-026-00209-y. ### Authors [Niloofar Khoshnam Rad](https://pubmed.ncbi.nlm.nih.gov/?term=Khoshnam+Rad+N&cauthor_id=42638128)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42638128/#short-view-affiliation-1 "Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran."), [Tayebeh Lakzaei](https://pubmed.ncbi.nlm.nih.gov/?term=Lakzaei+T&cauthor_id=42638128)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42638128/#short-view-affiliation-2 "Department of Internal Medicine, School of Medicine, Vali-e-Asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran."), [Maryam Nakhostin](https://pubmed.ncbi.nlm.nih.gov/?term=Nakhostin+M&cauthor_id=42638128)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42638128/#short-view-affiliation-3 "Department of Infectious Diseases and Tropical Medicine, Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. mnakhostin@gmail.com."), [Sara Soltanmohammadi](https://pubmed.ncbi.nlm.nih.gov/?term=Soltanmohammadi+S&cauthor_id=42638128)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42638128/#short-view-affiliation-4 "Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Sara.sm.68@gmail.com.") ### Affiliations * 1 Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. * 2 Department of Internal Medicine, School of Medicine, Vali-e-Asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran. * 3 Department of Infectious Diseases and Tropical Medicine, Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. mnakhostin@gmail.com. * 4 Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Sara.sm.68@gmail.com. * PMID: **42638128** * DOI: [ 10.1186/s41479-026-00209-y ](https://doi.org/10.1186/s41479-026-00209-y) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract Corticosteroids are cornerstone therapies in critically ill patients with severe pneumonia, acute respiratory distress syndrome (ARDS), and septic shock. However, their optimal application requires nuanced, syndrome-specific decision-making rather than a "one-size-fits-all" approach. This review provides a practical, evidence-based framework tailored specifically for adult patients in the ICU, defining a clear target audience of intensivists, pulmonologists, infectious disease specialists, and critical care pharmacists. We focus on six pillars: (1) the pathophysiology of critical illness-related corticosteroid insufficiency (CIRCI); (2) syndrome-specific agent selection supported by landmark trials; (3) precise dosing, administration, and tapering strategies; (4) structured safety monitoring; (5) management of high-risk drug-drug interactions; and (6) a comparative analysis of efficacy across agents. By synthesizing data from the CAPE COD, RECOVERY, DEXA-ARDS, APROCCHSS, and ADRENAL trials alongside the 2024 SCCM/ESICM focused guidelines, this guide offers a bedside roadmap for optimizing corticosteroid therapy in the ICU. Important distinctions are made between viral etiologies (benefit in COVID-19, systematic harm in influenza), and clinical exceptions are clearly defined. A dedicated section addresses the unique challenges of corticosteroid use in immunocompromised hosts, a population systematically excluded from landmark trials but increasingly encountered in ICU practice. Practical algorithms, monitoring tables, and drug interaction checklists are provided to support real-time clinical decision-making. **Keywords:** Acute respiratory distress syndrome; Corticosteroids; Critical illness; Dexamethasone; Drug interactions; Hydrocortisone; ICU; Pneumonia; Septic shock. © 2026. The Author(s). [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declarations. Ethics approval: Ethics approval was not required for this Review Article. Consent to participate / consent to publish: Not applicable. Use of AI statement: The authors acknowledge the use of the AI language model DeepSeek for text refinement, grammar checks, and improving narrative clarity. The authors reviewed, edited, and take full responsibility for the final content. Competing interests: The authors declare no competing interests. ## References 1. 1. Cronin L, Cook DJ, Carlet J, et al. Corticosteroid treatment for sepsis. Crit Care Med. 1995;23(8):1430–9. . - [DOI](https://doi.org/10.1097/00003246-199508000-00019) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/7634816/) 2. 1. Lefering R, Neugebauer EAM. Steroid controversy in sepsis and septic shock. Crit Care Med. 1995;23(7):1294–303. . - [DOI](https://doi.org/10.1097/00003246-199507000-00021) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/7600840/) 3. 1. Sobolewska J, Dzialach L, Kuca P, Witek P. Critical illness-related corticosteroid insufficiency (CIRCI) - an overview of pathogenesis, clinical presentation and management. Front Endocrinol (Lausanne). 2024;15. . 4. 1. Marik PE. Critical Illness-Related Corticosteroid Insufficiency. Chest. 2009;135(1):181–93. . - [DOI](https://doi.org/10.1378/chest.08-1149) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/19136406/) 5. 1. Cooper MS, Stewart PM. Adrenal Insufficiency in Critical Illness. J Intensive Care Med. 2007;22(6):348–62. . - [DOI](https://doi.org/10.1177/0885066607307832) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/18048877/) Show all 99 references ## Publication types * Review Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Review%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Review) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42638128/) [x] Cite Copy Download .nbib .nbib Format: AMA APA MLA NLM **Send To** * [Clipboard](https://pubmed.ncbi.nlm.nih.gov/42638128/) * [Email](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42638128%2F%23open-email-panel) * [Save](https://pubmed.ncbi.nlm.nih.gov/42638128/) * [My Bibliography](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42638128%2F%23open-bibliography-panel) * [Collections](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42638128%2F%23open-collections-panel) * [Citation Manager](https://pubmed.ncbi.nlm.nih.gov/42638128/) [x] NCBI Literature Resources [MeSH](https://www.ncbi.nlm.nih.gov/mesh/) [PMC](https://www.ncbi.nlm.nih.gov/pmc/) [Bookshelf](https://www.ncbi.nlm.nih.gov/books) [Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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