Intravenous hydrocortisone lowers the risk of hospital-acquired pneumonia in trauma patients
TUESDAY, March 22 (HealthDay News) -- Intravenous hydrocortisone decreases the risk of developing hospital-acquired pneumonia in intubated trauma patients, according to a study published in the March 23/30 issue of the Journal of the American Medical Association.
Antoine Roquilly, M.D., from the University Hospital of Nantes in France, and colleagues tested the efficacy of hydrocortisone in reducing hospital-acquired pneumonia in 149 trauma patients. From 2006 to 2009, 73 participants were randomized to receive continuous intravenous infusion of 200 mg hydrocortisone per day for five days, followed by 100 mg on day six and 50 mg on day five; 76 were assigned to a placebo. The main outcome was hospital-acquired pneumonia within 28 days, and mechanical ventilation duration, hyponatremia, and death were also measured.
The investigators found that 35.6 percent of patients receiving hydrocortisone, and 51.3 percent receiving a placebo, developed pneumonia (hazard ratio [HR], 0.51) according to an intention-to-treat (ITT) analysis. Similar results were seen in modified ITT analyses of those with corticosteroid insufficiency (35.7 percent with hydrocortisone, 54.4 percent receiving placebo, [HR, 0.47]). There was an increase in mechanical ventilation-free days in the hydrocortisone groups in the ITT and modified ITT analyses (four and six days, respectively). Hyponatremia developed in seven patients receiving placebo and in none receiving hydrocortisone. Six patients receiving hydrocortisone and four receiving placebo died.
"A stress dose of hydrocortisone for seven days is associated with a reduction in the rate of hospital-acquired pneumonia at day 28 together with a decreased requirement for mechanical ventilation and length of intensive care unit stay in trauma patients," the authors write.
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