CLINICAL QUESTION

Should steroids be administered to hospitalized patients with sepsis, acute respiratory distress syndrome (ARDS), and community-acquired pneumonia (CAP)?

BOTTOM LINE

An updated guideline from a panel of experts convened by the Society of Critical Care Medicine strongly recommends the administration of steroids for adults who are hospitalized with severe CAP. Conditional recommendations suggest that steroids should also be used in hospitalized adults with septic shock or ARDS. (Level of Evidence = 1a)

SYNOPSIS

The Society of Critical Care Medicine assembled an expert panel, including intensivists, pulmonologists, endocrinologists, nurses, and pharmacists, to provide evidence-based recommendations for the use of steroids in hospitalized adults and children with sepsis, ARDS, and CAP. The panel conducted systematic reviews to find the best evidence for a series of questions. A team of reviewers screened titles and abstracts, performed data extraction, and assessed risk of bias independently and in duplicate. Following a voting process, the panel issued four recommendations. A strong recommendation with moderate certainty of evidence supports the use of steroids for hospitalized adults with severe bacterial CAP, primarily based on evidence of decreased hospital mortality (relative risk = 0.62; 95% CI, 0.45–0.85). This mortality benefit was not seen in patients with less severe CAP. Two conditional recommendations suggest that steroids should be used in adults with septic shock or ARDS based on reduced short-term mortality. The guideline recommends against the use of high-dose, short-duration steroids for septic shock due to the risk of adverse effects. This is defined as greater than 400 mg/day of hydro-cortisone equivalent for less than 3 days.