Antoni Torres Martí *

Autor invitado por SIIC

El trabajo revisa la utilidad de los corticoides en la neumonía grave

USO DE CORTICOIDES EN LA NEUMONIA GRAVE

Recientes trabajos clínicos y experimentales sugieren que el controvertido uso de corticoides en la neumonía grave podría ser beneficioso, especialmente en aquellos casos con una elevada respuesta inflamatoria, aunque hacen falta estudios clínicos aleatorizados y controlados para generalizar su indicación.

*Antoni Torres Martí
describe para SIIC los aspectos relevantes de su trabajo
CORTICOSTEROIDS IN SEVERE PNEUMONIA
Institución principal de la investigación
*Hospital Clínic de Barcelona. Idibaps, Barcelona, España
Imprimir nota

Referencias bibliográficas
1. Alvares-Lerma F, Torres A. Severe community-acquired pneumonia. Curr Opin Crit Care 10(5):369-74, 2004.
2. American Thoracic Society. Guidelines for the manegement of adults with hospital-acquired pneumonia, ventilator-associated pneumonia and healthcare-associated pneumonia. Am J Respir Crit Care Med 171:388-416, 2005.
3. Leeper KV, Torres A. Community-acquired pneumonia in the intensive care unit. Clin Chest Med 16:155-71, 1995.
4. Heyland DK, Cook DJ, Griffith L, et al. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. Am J Respir Crit Care Med 159:1249-56, 1999.
5. Menéndez R, Torres A, Rodriguez de Castro F, et al. Predictive factors of clinical stability in community-acquired pneumonia. Thorax 59(11):960-965, 2004.
6. Ioanas M, Ferrer M, Cavalcanti M, et al. Causes and predictors of nonresponse to treatment of ICU-acquired pneumonia. Crit Care Med 32:938-945, 2004.
7. Sibille Y, Reynolds HY. Macrophages and polymorphonuclear neutrophils in lung defense and injury. Am Rev Respir Dis 141:471-501, 1990.
8. Nelson S, Bagby GJ, Bainton BG, et al. Compartimentalization of intraalveolar and systemic lipopolysaccharide -induced tumor necrosis factor and the pulmonary inflammatory response. J Infect Dis 159:189-194, 1989.
9. Martin C, Sauzx P, Mege JL, et al. Prognostic value of serum cytokines in septic shock. Intensive Care Med 20:272-277, 1994.
10. Dehoux MS, Boutten A, Ostinelli J, et al. Compartmentalized cytokine production within the human lung in unilateral pneumonia. Am J Respir Crit Care Med 150:710-716, 1994.
11. Monton C, Torres A, el-Ebiary M, et al. Cytokine expression in severe pneumonia: a bronchoalveolar study. Crit Care Med 27:1745-53, 1999.
12. Fernandez-Serrano S, Dorca J, Coromines M, et al. Molecular inflammatory response measured in blood of patients with severe community-acquired pneumonia. Clin Diag Lab Immunol 10:813-820, 2003.
13. Yende S, Tuomanen EI, Wunderink RG, et al. Pre-Infection systemic inflammatory markers and risk of hospitalisation due to pneumonia. Am J Respir Crit Care Med 172:535-541, 2005.
14. Rhen T, Cidlowsky JA. Antiinflammatory action of glucocorticoids - new mechanisms for old drugs. N Eng J Med 353:1711-23, 2005.
15. Briel M, Boscacci R, Furrer H, et al. Adjunctive corticoesteroids for Pneumocysti jirovecci pneumonia in patients with HIV infection: a meta-analysus of randomized controlled trials. BMC Infect Dis 5:101, 2005.
16. Keh D, Boenhke T, Weber-Cartens S, et al. Immunologic and hemodynamic effects of "low-dose" hydrocortisone in septic shock. A double blind, randomised, placebo-controlled, crossover study. Am J Respir Crit Care Med 167:512-520, 2003.
17. Lefering R, Neugebauer EM. Steroid controversy in sepsis and septic shock: a meta-analysis. Crit Care Med 23:1294-1303, 1995.
18. Montón C, Ewig S, Torres A, et al. Role of glucocorticoids on inflammatory response in nonimmunosuppressed patients with pneumonia: a pilot study. Eur Respir J 14:218-220, 1999.
19. Agustí C, Rañó A, Filella X, et al. Pulmonary infiltrates in patients receiving long-term glucocorticoid treatment. Etiology, prognostic factors and associated inflammatory response. Chest 123:488-498, 2003.
20. Ioanas M, Ferrer M, Cavalcanti M, et al. Causes and predictors of nonresponse to treatment of intensive care unit-acquired pneumonia. Crit Care Med 32:938-945, 2004.
21. Sibila O, Luna CM, Agustí C, et al. Effect of corticoesteroids in an animal modelo f ventilador-associated pneumonia. Am J Respir Crit Care Med 171:242-248, 2005.
22. Confalonieri R, Rubino G, Carbone A, et al. Hydrocortisone infusion for severe community-acquired pneumonia; a preliminar randomised study. Am J Respir Crit Care Med 171:242-248, 2005.
23. Briegel J, Kellermann W, Forst H, et al. Low-dose hydrocortisone infusion attenuates the systemic inflammatory response syndrome. Clin Invest 72:782-787, 1994.
24. Meersseman W, Vandecasteele SJ, Wilmer A, et al. Invasive Aspergillosis in critical ill patients without malignancies. Am J Respir Crit Care Med 170:621-625, 2004.
25. Annane D, Sébille V, Charpentier C, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 288:862-71, 2002.