Nedel WL, Nora DG, Salluh JIF, Lisboa T, Póvoa P. Corticosteroids for severe influenza pneumonia: A critical appraisal. World J Crit Care Med 2016; 5(1): 89-95 [PMID: 26855898 DOI: 10.5492/wjccm.v5.i1.89]
Corresponding Author of This Article
Jorge Ibrain Figueira Salluh, MD, PhD, D’or Institute for Research and Education, Rua Diniz Cordeiro, 30-3o andar, Botafogo, Rio de Janeiro 22281-100, Brazil. jorgesalluh@gmail.com
Research Domain of This Article
Allergy
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Crit Care Med. Feb 4, 2016; 5(1): 89-95 Published online Feb 4, 2016. doi: 10.5492/wjccm.v5.i1.89
Corticosteroids for severe influenza pneumonia: A critical appraisal
Wagner Luis Nedel, David Garcia Nora, Jorge Ibrain Figueira Salluh, Thiago Lisboa, Pedro Póvoa
Wagner Luis Nedel, Intensive Care Unit, Hospital Nossa Senhora da Conceição, Porto Alegre, RS 91350-200, Brazil
David Garcia Nora, Intensive Care Unit, Vila Franca de Xira Hospital, 2600-009 Vila Franca de Xira, Portugal
Jorge Ibrain Figueira Salluh, D’or Institute for Research and Education, Rio de Janeiro, RJ 22281-100, Brazil
Thiago Lisboa, Critical Care Department, Hospital de Clinicas de Porto Alegre, Post-Graduation Program (PPG) Pneumology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-903, Brazil
Pedro Póvoa, Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, 1169-056 Lisbon, Portugal
Pedro Póvoa, Nova Medical School, CEDOC, New University of Lisbon, 1169-056 Lisbon, Portugal
Author contributions: All authors reviewed, edited and approved the final manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jorge Ibrain Figueira Salluh, MD, PhD, D’or Institute for Research and Education, Rua Diniz Cordeiro, 30-3o andar, Botafogo, Rio de Janeiro 22281-100, Brazil. jorgesalluh@gmail.com
Telephone: +55-21-25383541
Received: September 28, 2015 Peer-review started: October 2, 2015 First decision: October 27, 2015 Revised: November 30, 2015 Accepted: January 8, 2016 Article in press: January 11, 2016 Published online: February 4, 2016 Processing time: 116 Days and 16.9 Hours
Abstract
Influenza pneumonia is associated with high number of severe cases requiring hospital and intensive care unit (ICU) admissions with high mortality. Systemic steroids are proposed as a valid therapeutic option even though its effects are still controversial. Heterogeneity of published data regarding study design, population demographics, severity of illness, dosing, type and timing of corticosteroids administered constitute an important limitation for drawing robust conclusions. However, it is reasonable to admit that, as it was not found any advantage of corticosteroid therapy in so diverse conditions, such beneficial effects do not exist at all. Its administration is likely to increase overall mortality and such trend is consistent regardless of the quality as well as the sample size of studies. Moreover it was shown that corticosteroids might be associated with higher incidence of hospital-acquired pneumonia and longer duration of mechanical ventilation and ICU stay. Finally, it is reasonable to conclude that corticosteroids failed to demonstrate any beneficial effects in the treatment of patients with severe influenza infection. Thus its current use in severe influenza pneumonia should be restricted to very selected cases and in the setting of clinical trials.
Core tip: This review article presents a critical appraisal to the use of corticosteroids in severe influenza infections covering the most relevant clinical studies, underlying mechanisms (pathophysiologic and pharmacologic aspects) and providing a scenario to help clinicians at bedside facing this challenging situation.
