Hydrocortisone infusion for severe community-acquired pneumonia: A preliminary randomized study
| Autor: | Francesco Blasi, Carbone Giorgio, Rosario Urbino, Reba Umberger, Piercarlo Parigi, G. Umberto Meduri, Giacomo Puccio, Alfredo Potena, Rossana Della Porta, Marco Piattella, Marco Confalonieri |
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| Přispěvatelé: | Confalonieri, M., Urbino, R., Potena, A., Piattella, M., Parigi, P., Puccio, G., Della Porta, R., Giorgio, C., Blasi, F., Umberger, R., Meduri, G. U. |
| Jazyk: | angličtina |
| Rok vydání: | 2005 |
| Předmět: |
Male
Hydrocortisone Thoracic Anti-Inflammatory Agents Respiratory failure Critical Care and Intensive Care Medicine law.invention Placebos Community-acquired pneumonia law C-reactive protein Severe sepsis Aged Anti-Bacterial Agents C-Reactive Protein Community-Acquired Infections Double-Blind Method Female Follow-Up Studies Hospitalization Humans Infusions Intravenous Length of Stay Middle Aged Multiple Organ Failure Oxygen Pneumonia Radiography Thoracic Shock Septic Survival Rate Community-Acquired Infection Infusions Intravenou medicine.diagnostic_test Shock Intensive care unit Anti-Inflammatory Agent Anesthesia Corticosteroid Intravenous Human Pulmonary and Respiratory Medicine medicine.medical_specialty Infusions medicine.drug_class Severe sepsi Follow-Up Studie Multicenter trial Intensive care Anti-Bacterial Agent medicine Placebo Critical illness-related corticosteroid insufficiency business.industry Septic shock Septic medicine.disease Surgery Radiography Chest radiograph business |
| Popis: | We hypothesize that hydrocortisone infusion in severe community-acquired pneumonia attenuates systemic inflammation and leads to earlier resolution of pneumonia and a reduction in sepsis-related complications. In a multicenter trial, patients admitted to the Intensive Care Unit (ICU) with severe community-acquired pneumonia received protocol-guided antibiotic treatment and were randomly assigned to hydrocortisone infusion or placebo. Hydrocortisone was given as an intravenous 200-mg bolus followed by infusion at a rate of 10 mg/hour for 7 days. Primary end-points of the study were improvement in Pa(O(2)):FI(O(2)) (Pa(O(2)):FI(O(2)) > 300 or >/= 100 increase from study entry) and multiple organ dysfunction syndrome (MODS) score by Study Day 8 and reduction in delayed septic shock. Forty-six patients entered the study. At study entry, the hydrocortisone group had lower Pa(O(2)):FI(O(2)), and higher chest radiograph score and C-reactive protein level. By Study Day 8, treated patients had, compared with control subjects, a significant improvement in Pa(O(2)):FI(O(2)) (p = 0.002) and chest radiograph score (p < 0.0001), and a significant reduction in C-reactive protein levels (p = 0.01), MODS score (p = 0.003), and delayed septic shock (p = 0.001). Hydrocortisone treatment was associated with a significant reduction in length of hospital stay (p = 0.03) and mortality (p = 0.009). |
| Databáze: | OpenAIRE |
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