Hydrocortisone infusion for severe community-acquired pneumonia - A preliminary randomized study
Hydrocortisone infusion for severe community-acquired pneumonia - A preliminary randomized study
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DOI：
10.1164/rccm.200406-808oc
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发表时间：
2005-02-01
影响因子：
24.7
通讯作者：
Meduri, GU
中科院分区：
文献类型：
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作者：
Confalonieri, M;Urbino, R;Meduri, GU
我们推测，在严重的社区获得性肺炎中，氢化可的松输注可减轻全身炎症，并导致肺炎的早期消退和脓毒症相关并发症的减少。在一项多中心试验中，患有严重社区获得性肺炎的重症监护室（ICU）患者接受了方案指导的抗生素治疗，并被随机分配到氢化可的松输注组或安慰剂组。氢化可的松静脉推注200 mg，然后以10 mg/h的速率输注7天。研究的主要终点是在研究第8天Pa-O2：Fi（O2）（Pa-O2：Fi（O2）> 300或从研究开始增加大于或等于100）和多器官功能障碍综合征（MODS）评分的改善以及迟发性脓毒性休克的减少。46例患者入组研究。在研究开始时，氢化可的松组的Pa-O2：Fi（O2）较低，胸片评分和C反应蛋白水平较高。到研究第8天，与对照组受试者相比，治疗组患者的Pa-O2：Fi（O2）（p = 0.002）和胸片评分（p <0.0001）显著改善，C反应蛋白水平（p = 0.01）、MODS评分（p = 0.003）和迟发性脓毒性休克（p = 0.001）显著降低。氢化可的松治疗与住院时间（p = 0.03）和死亡率（p = 0.009）显着减少相关。
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-O2:Fi(O2) (Pa-O2:Fi(O2) > 300 or greater than or equal to 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-O2:Fi(O2), 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-O2:Fi(O2) (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).