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Steroid May Cut Pneumonia Risk For Brain Trauma Patients

The steroid hydrocortisone can help reduce the serious and sometimes deadly risk that traumatic brain injury patients might develop pneumonia in the hospital, new French research suggests.

The study, conducted from 2006 to 2009 by Dr. Antoine Roquilly and colleagues of the University of Nantes, France, included 150 patients with severe trauma from seven ICUs in France. The purpose of the study was to examine whether treatment with stress-dose levels of hydrocortisone would reduce the prevalence of hospital-acquired pneumonia.

Patients were randomly assigned to a continuous intravenous infusion of either hydrocortisone (200 mg/d 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.

Based on experimental and clinical data, researchers concluded that hydrocortisone may decrease the occurrence and severity of hospital acquired pneumonia.

While more than 51 percent of the placebo patients ultimately developed pneumonia by the 28th day in the hospital, that figure dropped to under 36 percent among patients on the steroid regimen.

When looking solely at patients found to have an insufficient amount of naturally produced corticosteroid in their body, the breakdown of risk was similar: More than 54 percent of the placebo patients developed pneumonia, but the same was true for less than 36 percent of the hydrocortisone-treated patients.

Although the overall risk of death was comparable between the two groups, those in the steroid group had less need for mechanical ventilation assistance, less overall time in an ICU, and a lower risk of developing either acute lung injury or acute respiratory distress syndrome. In addition, none of the hydrocortisone patients developed a low concentration of blood sodium ("hyponatremia"), but more than 9 percent of the placebo group did, according to the study.

While some critics say the study was not large enough to draw definite conclusions, the researchers say the hydrocortisone regimen should be confirmed in trauma patients and investigated in other ICU populations, particularly TBI patients.

For more on medical safety issues, see the library of articles by Daytona Beach medical malpractice attorney.





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