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      Hydrocortisone infusion for severe community-acquired pneumonia: a preliminary randomized study.

      American journal of respiratory and critical care medicine

      Aged, Anti-Bacterial Agents, therapeutic use, Anti-Inflammatory Agents, administration & dosage, C-Reactive Protein, analysis, Community-Acquired Infections, drug therapy, Double-Blind Method, Female, Follow-Up Studies, Hospitalization, Humans, Hydrocortisone, Infusions, Intravenous, Length of Stay, Male, Middle Aged, Multiple Organ Failure, classification, Oxygen, blood, Placebos, Pneumonia, Radiography, Thoracic, Shock, Septic, Survival Rate

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          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(O(2)):FI(O(2)) (Pa(O(2)):FI(O(2)) > 300 or >/= 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(O(2)):FI(O(2)), 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(O(2)):FI(O(2)) (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).

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