Low-Dose Corticosteroids for Critically Ill Adults With Severe Pulmonary Infections
Jun 12, 2024
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Expert in critical care medicine, Romain Pirracchio, discusses the benefits of using low-dose corticosteroids in treating severe pulmonary infections. Topics include the use of corticosteroids in COVID-19 cases, positive impacts on mortality in Community-Acquired Pneumonia, and guidelines for timely initiation of treatment in critically ill patients.
Shift from high- to low-dose corticosteroids due to inflammation balance.
Meta-analysis shows low-dose corticosteroids reduce mortality and respiratory support need in severe CAP.
Deep dives
Use of Low-Dose Corticosteroids for Severe Pulmonary Infections
Dr. Perrecchio discusses the importance of managing severe pulmonary infections, which are a leading cause of adult mortality. The shift from high-dose to low-dose corticosteroids due to new understandings of inflammation balance is highlighted. The definition of low-dose corticosteroids, including doses below 400 milligrams per day of hydrocortisone equivalents, is explained. Specific examples from COVID-19 treatment protocols with 6 milligrams of dexamethasone daily are mentioned.
Meta-Analysis on Low-Dose Corticosteroids for Severe Community-Acquired Pneumonia (CAP)
A meta-analysis of low-dose corticosteroids for severe CAP reveals a reduction in mortality and respiratory support need. The significant results from the CAPT-COT trial, using 200 milligrams of cortisone for seven days, are discussed. Guidelines recommending the use of low-dose steroids for severe CAP and the importance of early initiation within 24 hours of severity signs are emphasized.
Impact of Low-Dose Corticosteroids on Septic Shock and ARDS
The benefits of low-dose corticosteroids on septic shock and ARDS are highlighted through subgroup analyses of trials. Evidence from the approach trial showing decreased mortality in sepsis patients with lung infection is discussed. The positive effects of early steroid administration on ARDS patients are mentioned. Potential adverse effects, such as hyperglycemia and secondary infections, are considered with caution in ICU patients receiving low-dose steroids.
Severe pulmonary infections are a leading cause of death in adults worldwide. Romain Pirracchio, MD, MPH, PhD, of the University of California-San Francisco, joins JAMA Deputy Editor Kristin L. Walter, MD, MS, to discuss Low-Dose Corticosteroids for Critically Ill Adults With Severe Pulmonary Infections. Related Content: