Corticosteroids for severe influenza pneumonia: A critical appraisal

作     者：Wagner Luis Nedel David Garcia Nora Jorge Ibrain Figueira Salluh Thiago Lisboa Pedro Póvoa 

作者机构：Intensive Care Unit Hospital Nossa Senhora da Concei??o Intensive Care Unit Vila Franca de Xira Hospital D’or Institute for Research and Education Critical Care Department Hospital de Clinicas de Porto Alegre Post-Graduation Program (PPG) Pneumology Universidade Federal do Rio Grande do Sul Polyvalent Intensive Care Unit S?o Francisco Xavier Hospital Centro Hospitalar de Lisboa Ocidental Nova Medical School CEDOC New University of Lisbon 

出 版 物：《World Journal of Critical Care Medicine》 (世界重症医学杂志)

年 卷 期：2016年第5卷第1期

页      面：89-95页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Influenza Mechanical ventilation Pneumonia Corticosteroids Respiratory failure 

摘      要：Influenza pneumonia is associated with high number of severe cases requiring hospital and intensive care unit(ICU) admissions with high mortality. Systemic steroids are proposed as a valid therapeutic option even though its effects are still controversial. Heterogeneity of published data regarding study design, population demographics, severity of illness, dosing, type and timing of corticosteroids administered constitute an important limitation for drawing robust conclusions. However, it is reasonable to admit that, as it was not found any advantage of corticosteroid therapy in so diverse conditions, such beneficial effects do not exist at all. Its administration is likely to increase overall mortality and such trend is consistent regardless of the quality as well as the sample size of studies. Moreover it was shown that corticosteroids might be associated with higher incidence of hospital-acquired pneumonia and longer duration of mechanical ventilation and ICU stay. Finally, it is reasonable to conclude that corticosteroids failed to demonstrate any beneficial effects in the treatment of patients with severe influenza infection. Thus its current use in s evere influenza pneumonia should be restricted to very selected cases and in the setting of clinical trials.