Patients admitted to a hospital with major trauma and treated with the steroid hydrocortisone were less likely to be diagnosed with hospital-acquired pneumonia than patients who received placebo, according to a study in JAMA.
Antoine Roquilly, MD, University of Nantes, France and colleagues conducted the Hydrocortisone Polytraumatise (HYPOLYTE) study to examine whether treatment with stress-dose levels of hydrocortisone would reduce the prevalence of hospital-acquired pneumonia. The randomized trial, conducted from November 2006 to August 2009, included 150 patients with severe trauma from 7 ICUs in France. Patients were randomly assigned to a continuous intravenous infusion of either hydrocortisone (200 mg a day for 5 days, followed by 100 mg on day 6 and 50 mg on day 7) or placebo. The treatment was stopped if patients had an appropriate adrenal response.
Twenty-six of 73 patients (35.6%) treated with hydrocortisone and 39 of 76 patients (51.3%) treated with placebo developed hospital-acquired pneumonia at day 28 of hospitalization. Twenty of 56 patients with corticosteroid insufficiency (35.7%) who were treated with hydrocortisone and 31 of 57 patients (54.4%) receiving placebo developed hospital-acquired pneumonia at day 28.
The average duration of mechanical ventilation-free days was 16 days in the hydrocortisone group and 12 days in the placebo group. Three of 73 patients (4.1%) in the hydrocortisone group and 11 of 76 patients (14.5%) in the placebo group developed acute lung injury or acute respiratory distress syndrome (ARDS). The average length of ICU stay was 18 days in the hydrocortisone group and 24 days in the placebo group.
Seven of 76 patients (9.2%) in the placebo group and none of the 73 in the hydrocortisone group developed hyponatremia (low concentration of sodium in the blood). For the entire study population, 6 of 73 patients (8.2%) died in the hydrocortisone group and 4 of 76 (5.3%) died in the placebo group.
“In conclusion, a stress dose of hydrocortisone for 7 days is associated with a reduction in the rate of hospital-acquired pneumonia at day 28 together with a decreased requirement for mechanical ventilation and length of ICU stay in trauma patients,” the authors wrote. “The effects and safety of corticosteroid therapy with stress-dose levels of hydrocortisone should be confirmed in trauma patients and investigated in other ICU populations, particularly in TBI patients.”