Anest. intenziv. Med. 2023;34(3):116-119 | DOI: 10.36290/aim.2023.039

Corticosteroids in severe community­‑acquired pneumonia - the end of the roller coaster?Review Article

Müller J.^{1, 2, 3}, Raděj J.^{1, 2}, Karvunidis T.^{1, 2, 3}, Valešová L.^{1, 2, 3}, Horák J.^{1, 2, 3}, Kříž M.^{1, 2}, Huňková E.^{1, 2}, Matějovič M.^{1, 2, 3}

¹ Jednotka intenzivní péče, I. interní klinika, Lékařská fakulta v Plzni, Univerzita Karlova

² Jednotka intenzivní péče, I. interní klinika, Fakultní nemocnice Plzeň

³ Biomedicínské centrum, Lékařská fakulta v Plzni, Univerzita Karlova, Plzeň

Community-acquired pneumonia (CAP) is an acute inflammatory disease of the lung parenchyma acquired outside the healthcare facilities or within 48 hours after admission to the hospital. Despite the availability of antibiotics, pneumonia remains the leading cause of death from infectious causes, according to World Health Organization data. Although it might seem that the treatment of lower respiratory tract infections is a closed chapter in a medical textbooks, it is quite the opposite. Our perception of pneumonia as a unifying diagnosis comes with a burden of heterogeneity and we need to approach each patient individually, based on their disease-specific phenotype. The adjuvant use of corticosteroids to modulate and dampen inflammation-induced lung injury in severe community-acquired pneumonia has been a matter of debate for the last twenty years. Up until recently, clinical trials and meta-analyses yielded conflicting results. Therefore, the last consensus of four respected European societies, recommends using corticosteroids in patients with severe community-acquired pneumonia only if septic shock is present. Unfortunately, those guidelines had been released shortly before the largest trial ever conducted on this group of patients (CAPE COD), which indicated different conclusions. This will probably lead to a reevaluation of the current strict recommendations for the use of corticosteroids. The following text aims to provide a brief clinically-oriented review of this controversial topic and present a perspective of our intensive care unit for further discussion until we have new relevant data and subsequent guidelines.

Keywords: severe community­‑acquired pneumonia, corticosteroids, sepsis, hyperinflammation, inflammation­‑induced lung injury, immunomodulation.

Received: June 7, 2023; Revised: August 24, 2023; Accepted: September 22, 2023; Prepublished online: October 24, 2023; Published: October 31, 2023  Show citation