Category: Critical Care
Keywords: Pneumonia, Corticosteroids, Steroids, Respiratory Failure, Infection (PubMed Search)
Posted: 11/9/2023 by Mark Sutherland, MD
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For the folks who have been in practice for a while, you may be aware of the roller-coaster evidence base looking at steroids for pneumonia. Once thought to be beneficial and clearly indicated, of late steroids for pneumonia have fallen out of favor. Hamad et al have published an excellent (and brief) review in Clinical Infectious Diseases which suggests the pendulum might be swinging back in favor of giving steroids to patients with pneumonia. It's a ~5 minute read, so I recommend glancing through it yourself, but below are my two cents (solely my opinion) on where we are with steroids for pneumonia.
Take Home Points (OPINION ALERT):
1) When you have a condition present that you consider an indication for steroids (e.g. severe COVID-19 for sure; septic shock, s. pneumo infection, and ARDS depending on how you feel about the existing literature) --> strongly consider giving steroids unless there's a contraindication
2) When you have an undifferentiated patient who MAY have one of these conditions (e.g. pneumonia with COVID pending, patient potentially in ARDS or high risk of going into ARDS, etc) who is very sick --> it is reasonable to give steroids (if no contraindication) or not give steroids. My tendency is to lean towards giving steroids in these cases, but do be aware that society guidelines recommend against steroids here (although debatable if they just haven't caught up to more recent literature)
3) When you have an undifferentiated patient who may have one of these conditions, but is NOT very sick --> I do not think there is significant enough evidence to support empiric steroids
4) Factors that might push you one way or another:
