Tours. According to a study published Tuesday, ICU patients with severe community-acquired pneumonia (CAP) benefit from 200 mg intravenous hydrocortisone treatment daily. The therapy not only increased the likelihood of surviving the disease, but also that CAP patients would require intubation.
A team of scientists from the Franco-Belgian network CRICS-TriGGERSep (Clinical Research in Intensive Care and Sepsis – Trial Group for Global Evaluation and Research in Sepsis) examined a total of 800 patients in the multicentre, randomized-controlled phase III study, who were admitted to the ICU for CAP were treated with either hydrocortisone or placebo in addition to standard antibiotic therapy and supportive care (NEJM 2023; online March 21). Depending on the course, hydrocortisone was administered at the full dose for either four or eight days and then tapered off over eight or 14 days.
Reduced need for vasopressors
After 28 days, significantly fewer patients had died, 6.2 percent in the hydrocortisone group versus 11.9 percent in the placebo group. In the course of the study, 18 percent of 222 and 29.5 percent of 220 participants in the respective group had to be intubated if they were not already requiring ventilation when they were admitted.
15.3 percent of 359 people in the hydrocortisone group and 25 percent of 344 in the placebo group who did not initially require vasopressor treatment eventually required it. Those treated with the steroid needed more insulin to lower high blood sugar levels in the first week of treatment. However, nosocomial infections and gastrointestinal bleeding occurred with similar frequency in both cohorts.