In Trauma Patients, Steroids May Reduce Pneumonia Risk

Providing severe trauma patients with doses of steroids may reduce their risk of developing pneumonia in the hospital, a new study says.

Patients that received low doses of the steroid medication hydrocortisone for seven days had a 15 percent lower risk of developing pneumonia compared with those that received a placebo.

Patients that received steroids also spent less time in the intensive care unit (ICU) and were less likely to develop acute respiratory distress syndrome, an often fatal lung condition that can be brought on by pneumonia.

The treatment may be particularly important for traumatic brain injury patients because these patients are especially vulnerable to pneumonia, said study researcher Dr. Karim Asehnoune, of the University of Nantes in France.

However, the study was quite small, and larger trials are needed before clinical practice is changed, said Dr. Eileen M. Bulger and Dr. Joseph Cuschieri, both of the University of Washington in Seattle, who wrote an editorial accompanying the study. In particular, research should investigate whether this drug increases the risk of death in trauma patients, a question not addressed by this study, Bulger and Cuschieri said.

The study and editorial will be published tomorrow (March 23) in the Journal of the American Medical Association.

Severe trauma and pneumonia risk

Patients who experience severe trauma are particularly susceptible to catching pneumonia because their immune systems are compromised after the traumatic event. Around 40 to 60 percent of severe trauma patients worldwide develop hospital-acquired pneumonia, most of whom are traumatic brain injury patients, the researchers say. Pneumonia in these patients can increase the risk of death and amount of time patients stay in the hospital.

Severe trauma patients have excess amounts of inflammation in their bodies. This hyperinflammatory response is thought to prevent the body from reacting to invaders, such as the bacteria that cause pneumonia, Asehnoune said. Steroids can decrease the inflammatory response, and possibly make it easier for the body to thwart off infection.

The study involved about 150 patients from seven centers in France who were admitted to the hospital with severe trauma (two or more traumatic injuries) between November 2006 and August 2009. Within 36 hours of experiencing trauma, patients received either low doses of hydrocortisone or a placebo.

Steroids may help

After 28 days of hospitalization, 35.6 percent of patients who received hydrocortisone developed pneumonia compared with 51.3 percent who received the placebo.

The average time patients stayed in the ICU was 18 days for those treated with hydrocortisone and 24 days for those treated with the placebo.

Hydrocortisone also reduced the amount of time patients needed to be placed on a ventilator to breathe. Being on a ventilator can increase the risk of pneumonia. Also, if patients are on a ventilator, they cannot leave the ICU, Asehnoune said.

The patients who will benefit the most from hydrocortisone treatment are those who do not produce sufficient amounts of the hormone cortisol after their injury, Asehnoune said. Hydrocortisone is the pharmaceutical name for cortisol.

The researchers are currently conducting another study specifically looking at the effects of hydrocortisone on patients who have traumatic brain injuries, Asehnoune said.

Pass it on: Low doses of steroids may reduce the incidence of pneumonia in patients with severe trauma.

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