Thread by @teddyhla

NEXT: Corticosteroids in Bacterial pneumonia? By @antoniotorres Barcelona Spain.
Starting with 30-day mortality of severe CAP is very high. Microbial etiology is Strep pneumoniae, Legionella, Staph aureus, Pseudomonas and Polymicrobial #LIVES2022
#ventilation
@ESICM

@AntonioTorres @ESICM anti-inflamm Rx :steroids / macrolides may reduce mortality. Rationale : local and systemic inflammatory responses are increased in CAP, thus "down-regularte" them. Delfi consensus : no recommendation for any CAP but for in icu CAP patients, recommended. #steroids #ards @ESICM

@AntonioTorres @ESICM Rx steroids 0.5mg/kg/12 hr methylpred for 5 days for CAP. However influenza patient -- steroids may increase mortality. What happen also with Macrolides and Steroids combination ? In study : no synergistic effect and no additional improvement. #steroids #cap #ventilation @ESICM

@AntonioTorres @ESICM Adverse events: increased risk of re-admission. Do not use hydrocortisone -- metaanalysis : Huang et al Medicine (2019)98:13 - hydrocrotisone does not seem t work. #LIVES2022
#ventilation #steroids #ards

@AntonioTorres @ESICM Final : recommends more "trials" effect of steroids on mortality are no well defined, small trials, inflammatory status not considered. NOT ALL STEROIDS is the SAME. SO NO EASY ANSWER YET ! #steroids #LIVES2022

Interesting meta analysis findings

In conclusion : Severe CAP with shock popn - steroids porbably decrease mortality and increase free days of MV. Phenotypes + genotypes need to be in the centre of this research. Heterogeneity of Rx effects interesting to see. #LIVES2022
#ventilation
#steroids #ards
@ESICM

@ESICM Q: some patients may have steroid "resistance" how do we determine it? Ans: no way of finding this out in a clinical practice. Laboratory research ongoing for looking at this. Transcriptomic signatures are being looked at but not available at bed-side. #LIVES2022
@ESICM

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