Literature Review: Community-Acquired Pneumonia

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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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Dequin PF, Meziani F, Quenot JP, Kamel T, Ricard JD, Badie J, Reignier J, Heming N, Plantefève G, Souweine B, Voiriot G, Colin G, Frat JP, Mira JP, Barbarot N, François B, Louis G, Gibot S, Guitton C, Giacardi C, Hraiech S, Vimeux S, L’Her E, Faure H, Herbrecht JE, Bouisse C, Joret A, Terzi N, Gacouin A, Quentin C, Jourdain M, Leclerc M, Coffre C, Bourgoin H, Lengellé C, Caille-Fénérol C, Giraudeau B, Le Gouge A; CRICS-TriGGERSep Network. Hydrocortisone in Severe Community-Acquired Pneumonia. N Engl J Med. 2023 Mar 21. doi: 10.1056/NEJMoa2215145. Epub ahead of print. PMID: 36942789.

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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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