Tuberc Respir Dis.  2006 Apr;60(4):419-425. 10.4046/trd.2006.60.4.419.

Efficacy of Low-dose Hydrocortisone Infusion for Patients with Severe Community-acquired Pneumonia Who Invasive Mechanical Ventilation

• Kim HC
• Lee SJ
• Ham HS
• Cho YJ
• Jeong YY
• Lee JD
• Hwang YS

• KMID: 1719367
• DOI: http://doi.org/10.4046/trd.2006.60.4.419

Abstract

BACKGROUND: Severe community-acquired pneumonia (CAP) can develop into respiratory failure that requires mechanical ventilation (MV), which is associated with a higher rate of mortality. It was recently reported that a hydrocortisone infusion in severe CAP patients was associated with a significant reduction in the length of the hospital stay and mortality. This study evaluated efficacy of a hydrocortisone infusion for patients with severe CAP requiring MV.
METHODS
From February 2005 to July 2005, 13 patients (M : F = 10 : 3, mean age: 68.6+/-14.1 years), who were diagnosed with severe CAP and required MV, were enrolled in this study. Hydrocortisone was administered as an intravenous 200mg loading bolus, which was followed by an infusion at a rate of 10mg/hour for 7 days. The control group was comprised of patients with severe CAP requiring MV but in whom corticosteroid was not used before study period. The clinical and physiologic parameters on or by day 8 and the outcome in the hydrocortisone infusion group were compared with those in the control group.
RESULTS
1) There was no significant difference in age, gender ratio, SAPS II, SOFA score, temperature, leukocyte count, PaO2/FiO2 (P/F) ratio, the number of patients with P/F ratio < 200, chest radiograph score, lung injury score and catecholamine-dependent septic shock between the hydrocortisone infusion group and control group at day 1. 2) At day 8, the proportion of patients with an improvement in the P/F ratio > or = 100 and the chest radiograph score was significantly higher in the hydrocortisone infusion group than in the control group (61.5% vs. 15.4%, 76.9% vs. 23.1%, p<0.05). However, there was no significant difference in the other clinical and physiologic parameters. 3). There was no significant difference in the duration of the MV, ICU stay, hospital stay and 10th and 30th day mortality between the two groups.
CONCLUSION
Hydrocortisone infusion for patients with severe CAP requiring invasive mechanical ventilation may be effective in improving the level of oxygenation and the chest radiograph score.

Keyword

Severe community-acquired pneumonia; Hydrocortisone

MeSH Terms

Humans
Hydrocortisone*
Length of Stay
Leukocyte Count
Lung Injury
Mortality
Oxygen
Pneumonia*
Radiography, Thoracic
Respiration, Artificial*
Respiratory Insufficiency
Shock, Septic
Hydrocortisone
Oxygen

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