Objectives Outline which conditions causing acute respiratory failure benefit from corticosteroids. 1. Describe the studies providing data for efficacy of corticosteroids in these conditions. 2. Determine the biologic rationale for the use of corticosteroids in ARDS. 3. Discern the complications of corticosteroid therapy. 4. Provide recommendations for corticosteroid regimens in treating these conditions causing acute respiratory failure. 5. Abbreviations AEP = acute eosinophilic pneumonia;

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... -GBM = anti-glomerular basement membrane; BMT = bone marrow transplantation; BOOP = bronchiolitis obliterans organizing pneumonia; CK = creatine kinase; FEF 25-75% = forced midexpiratory flow rate; FIO 2 = fraction of inspired oxygen; IL = interleukin; LIS = lung injury score; MPA = microscopic polyangiitis; PCP = Pneumocystis carinii pneumonia; PEFR = peak expiratory flow rate; SLE = systemic lupus erythematosus; SpO 2 = oxygen saturation measured by pulse oximetry; TNF = tumor necrosis factor; WG = Wegener's granulomatosis The pulmonologist/intensivist may encounter a number of conditions that cause acute respiratory failure, and many of these conditions may potentially benefit from treatment with corticosteroids. In this lesson, we examine the data and rationale for corticosteroid use in conditions that are most likely to cause acute respiratory failure requiring admission to the ICU. We provide our recommendations for treatment based on the available data, recognizing that randomized, double-blind, placebo-controlled trials may be lacking. Our focus is primarily on human studies rather than in vitro or experimental models. Given the space limitations, we will not discuss the mechanisms of action for corticosteroids; we refer the interested reader to the excellent discussion provided by Stellato and colleagues.