title: Adjunctive therapies in severe pneumonia in critical care patients.
abstract: OBJECTIVE
  To review available evidence for the role of adjunctive therapies in severe pneumonia.
  
  
  METHODS
  We focused on therapies that have attracted recently interest such as glucocorticosteroids (GCs), statins and recombinant activated protein-C.
  
  
  RESULTS
  Experimental animal and human studies showed that GCs are able to modulate the inflammatory response and may offer a benefit in patients with severe sepsis. Randomized trials in pneumonia are few, mostly limited in septic shock and ARDS patients. Recombinant activated protein C is a potent anticoagulant and profibrinolytic enzyme which can inhibit the systemic inflammatory response. Available data, although limited, showed that activated protein C can reduce mortality in severe sepsis, especially in severe pneumonia due to S. Pneumoniae. Statins have pleiotropic properties which can affect the inflammatory cascade. The use of statins has been found to be associated with decreased mortality in some studies with pneumina whereas the use of statins was associated with increased risk of death in others. However, data come from observational or retrospective studies.
  
  
  CONCLUSIONS
  Treatment with GCs may modulate the inflammatory response in critically ill patients with pneumonia but a clear effect of steroids on survival is debatable. The administration of GCs should be considered in patients with severe pneumonia when vasopressor dependent septic shock. Activated protein-C may be considered in patients with severe CAP or HAP and sepsis or organ failure. The role of statins in the management of severe pneumonia remains controversial until data from clinical trails will be available.
authors.affiliation: Department of Critical Care Medicine, University Hospital of Larisa, University of Thessaly, Larisa 41000, Greece.
authors.forename: N
authors.initials: N
authors.lastname: Tzovaras
authors.forename: M
authors.initials: M
authors.lastname: Karvouniaris
authors.forename: D
authors.initials: D
authors.lastname: Makris
authors.forename: E
authors.initials: E
authors.lastname: Zakynthinos
mesh_terms: D000818:Animals; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000503:physiopathology; D016638:Critical Illness; D003428:Cross Infection / Q000188:drug therapy / Q000503:physiopathology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007249:Inflammation / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D011014:Pneumonia / Q000188:drug therapy* / Q000503:physiopathology; D011486:Protein C / Q000627:therapeutic use; D018805:Sepsis / Q000188:drug therapy* / Q000503:physiopathology; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D005938:Glucocorticoids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011486:Protein C