Hydrocortisone and fludrocortisone for prevention of hospital-acquired pneumonia in patients with severe traumatic …

Background

Hospital-acquired pneumonia is common after traumatic brain injury, and might be partly a result of traumatic brain injury-induced adrenal insufficiency. We tested the efficacy of low-dose hydrocortisone with fludrocortisone for the prevention of hospital-acquired pneumonia.

From Sept 1, 2010, to Nov 29, 2012, we enrolled 336 patients (168 assigned to each group). Eight patients withdrew consent. At day 28, 74 of 165 patients (45%) in the steroid group and 87 of 163 (53%) in the placebo group had developed one or more episodes of hospital-acquired pneumonia (hazard ratio [HR] 075; 95% CI 055103, p=007). In intention-to-treat analysis, we recorded 86 episodes of hospital-acquired pneumonia in the steroid group versus 110 in the placebo group (median 0, IQR 01 vs median 1, IQR 01 cases per patient, p=007). In modified intention-to-treat analyses, the HR for hospital-acquired pneumonia with steroids versus placebo was 080 (95% CI 056114, p=022) in patients with adrenal insufficiency, and, in an exploratory preplanned analysis, 048 (023101; p=005) in patients with normal adrenal function. We recorded no adverse events related to treatment.

Low-dose hydrocortisone with fludrocortisone did not improve the outcome of patients with traumatic brain injury. However, the study was underpowered because the proportion of patients with hospital-acquired pneumonia in the placebo group was lower than expected. The results were close to statistical significance for efficacy, meaning that further studies are therefore needed.

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Hydrocortisone and fludrocortisone for prevention of hospital-acquired pneumonia in patients with severe traumatic ...