title: Does low-dose hydrocortisone therapy prevent ventilator-associated pneumonia in trauma patients?
abstract: The incidence of ventilator-associated pneumonia (VAP) is particularly high in trauma patients. Immediate acute inflammation response is one of the hallmarks of multiple trauma. This phenomenon is associated with an immunosuppression state and may increase the risk of VAP. In our study, we aimed to evaluate whether low-dose steroids prevent VAP onset in multiple trauma patients. All adult patients admitted in our intensive care unit (ICU) for multiple trauma with predicted duration of mechanical ventilation over 48 hours were included. We compared 2 different periods: a retrospective cohort of patients who did not receive low-dose steroids for VAP prevention and a prospective cohort of patients who received hydrocortisone with a dose of 100 mg/8 hours for a scheduled period of 7 days. We included 175 patients: 92 in the steroids (-) group and 83 in the steroids (+) group. The incidence of VAP was not different between the 2 studied groups (29.3% and 26.5%; P = 0.676). When predictive factors of VAP onset were studied in multivariate analysis, steroids had no preventive effect on VAP [OR = 1.6; 95% confidence interval, 0.73-3.6; P = 0.234]. We did not find any difference between the 2 groups, neither in terms of ICU length of stay (respectively, 11 ± 9.7 days vs. 12.3 ± 10.7 days; P = 0.372) nor in terms of ICU mortality (29.3% vs 24.1%; P = 0.434).
authors.affiliation: University of medicine, Sfax, Tunisia; Habib Bourguiba University Hospital, Sfax, Tunisia.
authors.forename: Anis
authors.initials: A
authors.lastname: Chaari
authors.forename: Mariem
authors.initials: M
authors.lastname: El Habib
authors.forename: Hatem
authors.initials: H
authors.lastname: Ghdhoun
authors.forename: Najla
authors.initials: N
authors.lastname: Ben Algia
authors.forename: Kamilia
authors.initials: K
authors.lastname: Chtara
authors.forename: Chokri
authors.initials: C
authors.lastname: Ben Hamida
authors.forename: Hedy
authors.initials: H
authors.lastname: Chelly
authors.forename: Mabrouk
authors.initials: M
authors.lastname: Bahloul
authors.forename: Mounir
authors.initials: M
authors.lastname: Bouaziz
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000627:therapeutic use*; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000628:therapy*; D015999:Multivariate Analysis; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone