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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Monday, April 24, 2023

Steroids for pneumonia

First10EM - By Justin Morgenstern - April 24, 2023
Bottom line
Both CAPE COD and ESCAPe are high quality trials. The results are somewhat conflicting, and we should be cautious about over-emphasizing the positive result over the negative result. That being said, overall mortality was 2% lower in the steroid group in ESCAPe, and the trial ended up being significantly underpowered. I think the best current guess is that there is a small mortality benefit of steroids in patients with severe community acquired pneumonia in the ICU. (My guess is it will be closer to the 2% of ESCAPe than the 6% of CAPE COD.) With mixed results, we should be very cautious about being too definitive in our conclusions. This should remain an area of active research. Clinically speaking, I will provide steroids to the select group of ICU patients with community acquired pneumonia who don’t have contra-indications to steroids, but I will be very cautious to guard against indication creep, because we know steroids have many significant complications.