Literature Review: Community-Acquired Pneumonia

Literature Review Section Instructions

1. Begin by providing an overview of the topic: Start the literature review section by introducing the focus of your review, which is based on the 2019 ATS/IDSA guidelines and the PACU Literature Review #23. Briefly explain the significance of the topic and its relevance to the field.
   
2. Conclude the literature review section: Summarize the main findings and conclusions derived from the 2019 ATS/IDSA guidelines and the PACU Literature Review #23. Highlight any overarching themes, unresolved issues, or recommendations for future research. Emphasize the importance of the reviewed literature in advancing the knowledge and understanding of the topic.
   
3. Quiz: complete the quiz at the bottom of this section

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STUDY OBJECTIVE

• To determine whether the anti-inflammatory and immunomodulatory effects of glucocorticoids could decrease mortality among patients with severe community-acquired pneumonia.

STUDY DESIGN

• This was a phase 3, multicenter, double-blind, randomized, controlled trial conducted in 31 French centers.

Study Intervention & Comparison

• The intervention group received intravenous hydrocortisone (200 mg daily for either 4 or 8 days as determined by clinical improvement, followed by tapering for a total of 8 or 14 days). The comparison group received placebo.

Results

• Primary Safety Outcome
  • Death at 28 days.
  • 25 of 400 patients (6.2%) in the hydrocortisone group and in 47 of 395 patients (11.9%) in the placebo group (absolute difference, -5.6 percentage points; 95% CI, -9.6 to -1.7; P = 0.006).
• Secondary Safety Outcome
  • Endotracheal intubation among patients not undergoing mechanical ventilation at baseline and the initiation of vasopressors among patients not receiving them at baseline.
    • 40 of 222 (18.0%) in the hydrocortisone group and in 65 of 220 (29.5%) in the placebo group (hazard ratio, 0.59; 95% CI, 0.40 to 0.86)

Summary

• Among patients with severe community-acquired pneumonia being treated in the ICU, hydrocortisone therapy reduced the rate of death by day 28 compared to the placebo group. Early hydrocortisone therapy was also associated with a decreased risk of endotracheal intubation and the initiation of vasopressors. The study suggests that glucocorticoids have a potential benefit in reducing mortality among patients with severe community-acquired pneumonia in the ICU setting. However, further research is needed to investigate the potential risks and benefits of this therapy.

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