Early corticosteroids in severe influenza A/H1N1 pneumonia and acute respiratory distress syndrome - PubMed (original) (raw)
. 2011 May 1;183(9):1200-6.
doi: 10.1164/rccm.201101-0135OC. Epub 2011 Mar 4.
Collaborators, Affiliations
- PMID: 21471082
- DOI: 10.1164/rccm.201101-0135OC
Early corticosteroids in severe influenza A/H1N1 pneumonia and acute respiratory distress syndrome
Christian Brun-Buisson et al. Am J Respir Crit Care Med. 2011.
Abstract
Rationale: Despite their controversial role, corticosteroids are often administered to patients with adult respiratory distress syndrome (ARDS) secondary to viral pneumonia.
Objectives: To analyze the impact of corticosteroid therapy on outcomes of patients having ARDS associated with influenza A/H1N1 pneumonia.
Methods: Patients from the French registry of critically ill patients with influenza A/H1N1v 2009 infection were selected if fulfilling criteria for ARDS, excluding patients having other indication for corticosteroids, or decompensated underlying disease as the primary cause for intensive care unit admission. Survival to hospital discharge was analyzed using Cox regression, accounting for the time to administration of steroids, and after adjustment on the propensity for receiving steroid therapy.
Measurements and main results: Of 208 patients with ARDS, 83 (39.9%) received corticosteroids (median initial dose of 270 mg equivalent hydrocortisone per day for a median of 11 d). Steroid therapy was associated with death, both in crude analysis (33.7 vs. 16.8%; hazard ratio, 2.4; 95% CI, 1.3-4.3; P = 0.004) and after propensity score-adjusted analysis (adjusted hazard ratio, 2.82; 95% CI, 1.5-5.4; P = 0.002), controlling for an admission severity Simplified Acute Physiology Score, version 3, greater than 50, initial administration of vasopressors, and immunodepression. Early therapy (≤ 3 d of mechanical ventilation) appeared more strongly associated with mortality than late administration. Patients receiving steroids had more acquired pneumonia and a trend to a longer duration of ventilation.
Conclusions: Our study provides no evidence of a beneficial effect of corticosteroids in patients with ARDS secondary to influenza pneumonia, but suggests that very early corticosteroid therapy may be harmful.
Comment in
- Pro: the illegitimate crusade against corticosteroids for severe H1N1 pneumonia.
Annane D. Annane D. Am J Respir Crit Care Med. 2011 May 1;183(9):1125-6. doi: 10.1164/rccm.201102-0345ED. Am J Respir Crit Care Med. 2011. PMID: 21531952 No abstract available. - Con: corticosteroids are not indicated for treatment of acute lung injury from H1N1 viral pneumonia.
Matthay MA, Liu KD. Matthay MA, et al. Am J Respir Crit Care Med. 2011 May 1;183(9):1127-8. doi: 10.1164/rccm.201103-0395ED. Am J Respir Crit Care Med. 2011. PMID: 21531953 Free PMC article. No abstract available. - [Should corticosteroids be used in A/H1N1 influenza ARDS? Rather not but still debated].
Groupe Bibliographique de la SPILF. Groupe Bibliographique de la SPILF. Med Mal Infect. 2011 Nov;41(11):625-6. doi: 10.1016/j.medmal.2011.09.007. Med Mal Infect. 2011. PMID: 22229151 French. No abstract available. - Selective decontamination of the digestive tract may reinforce the efficacy of corticosteroids.
Silvestri L, Rommes JH, Petros AJ, Taylor N, van Saene HK. Silvestri L, et al. Am J Respir Crit Care Med. 2012 Feb 1;185(3):344. doi: 10.1164/ajrccm.185.3.344. Am J Respir Crit Care Med. 2012. PMID: 22298370 No abstract available.
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