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Kim, Lee, Ham, Cho, Jeong, Lee, and Hwang: Efficacy of Low-dose Hydrocortisone Infusion for Patients with Severe Community-acquired Pneumonia Who Invasive Mechanical Ventilation
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2006; 60(4): 419-425.

Published online: 30 April 2006

DOI: https://doi.org/10.4046/trd.2006.60.4.419

Efficacy of Low-dose Hydrocortisone Infusion for Patients with Severe Community-acquired Pneumonia Who Invasive Mechanical Ventilation

Ho Cheol Kim, M.D., Seung Jun Lee, M.D., Hyoun Seok Ham, M.D., Yu Ji Cho, M.D., Yi Yeong Jeong, M.D., Jong Deok Lee, M.D., Young Sil Hwang, M.D.

Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea.

Address for correspondence: Young Sil Hwang, M.D. Department of Internal Medicine, College of Medicine, Gyeongsang National University. 92 Chilam Dong, Jinju, 660-751, Korea. Phone: 055-750-8068, Fax: 055-750-8618, yshwang@nongae.gsnu.ac.kr

Received 1 January 2006       Accepted 21 April 2006

Copyright © 2006 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Background

Severe community-acquired pneumonia (CAP) can develop into respiratory failure that requires mechanical ventilation (MV), which is associated with a higher rate of mortality. It was recently reported that a hydrocortisone infusion in severe CAP patients was associated with a significant reduction in the length of the hospital stay and mortality. This study evaluated efficacy of a hydrocortisone infusion for patients with severe CAP requiring MV.

Methods

From February 2005 to July 2005, 13 patients (M : F = 10 : 3, mean age: 68.6±14.1 years), who were diagnosed with severe CAP and required MV, were enrolled in this study. Hydrocortisone was administered as an intravenous 200mg loading bolus, which was followed by an infusion at a rate of 10mg/hour for 7 days. The control group was comprised of patients with severe CAP requiring MV but in whom corticosteroid was not used before study period. The clinical and physiologic parameters on or by day 8 and the outcome in the hydrocortisone infusion group were compared with those in the control group.

Results

1) There was no significant difference in age, gender ratio, SAPS II, SOFA score, temperature, leukocyte count, PaO2/FiO2 (P/F) ratio, the number of patients with P/F ratio < 200, chest radiograph score, lung injury score and catecholamine-dependent septic shock between the hydrocortisone infusion group and control group at day 1. 2) At day 8, the proportion of patients with an improvement in the P/F ratio ≥ 100 and the chest radiograph score was significantly higher in the hydrocortisone infusion group than in the control group (61.5% vs. 15.4%, 76.9% vs. 23.1%, p < 0.05). However, there was no significant difference in the other clinical and physiologic parameters. 3). There was no significant difference in the duration of the MV, ICU stay, hospital stay and 10th and 30th day mortality between the two groups.

Conclusion

Hydrocortisone infusion for patients with severe CAP requiring invasive mechanical ventilation may be effective in improving the level of oxygenation and the chest radiograph score.

Keywords: Severe community-acquired pneumonia, Hydrocortisone

Figures and Tables

Table 1
Clinical and physiologic characteristics at study entry
trd-60-419-i001

Data are presented as the mean value ± SD or number of patients with percentage.

Definition of abbreviations: SAPS II = Simplified acute physiology score II; SOFA= Sequential organ failure assessment; P/F = PaO2/FiO2

Table 2
Clinical and physiologic characteristics at or by study day 8
trd-60-419-i002

Data are presented as the mean value ± SD or number of patients with percentage.

Definition of abbreviations: MV = Mechanical ventilation, P/F = PaO2/FiO2; SOFA= Sequential organ failure assessment, MODS = multiple organ dysfunction syndrome, ARDS = acute respiratory distress syndrome

Table 3
Clinical outcome
trd-60-419-i003

Data are presented as the mean value ± SD or number of patients with percentage.

Definition of abbreviations : ICU = intensive care unit, MV = mechanical ventilation

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