What is the role of corticosteroids in the management of aspiration pneumonia?

Updated: Aug 15, 2018
  • Author: Justina Gamache, MD; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Answer

Answer

Historically corticosteroids have been used in the treatment of aspiration pneumonitis, but randomized control studies have been unable to demonstrate a benefit to using high-dose corticosteroids.

The role of supplementing corticosteroids in patients with hypotension from septic shock remains controversial. Previously, it was recommended that septic patients who were hypotensive despite fluid resuscitation and vasopressor support be screened for occult adrenal insufficiency. However, current guidelines recommend empiric therapy with stress-dose steroids in these patients who remain hypotensive despite fluids and pressors, to avoid delay in treatment of presumed adrenal insufficiency. [26]

The role of corticosteroids in patients hospitalized for community-acquired pneumonia (CAP) was evaluated in a 2015 meta-analysis of 13 randomized controlled trials, which found with high certainty that systemic corticosteroid steroid treatment reduced the duration of hospitalization by approximately 1 day and had a 5% absolute reduction in risk for mechanical ventilation. [27] The study also found that patients with severe pneumonia who received systemic corticosteroids had an apparent mortality benefit over patients with severe pneumonia who did not receive systemic corticosteroids, which may be related to the higher incidence of acute respiratory distress syndrome and the need for mechanical ventilation in patients with severe pneumonia. However, this evidence was rated moderate as the confidence interval crossed 1 and because of a possible subgroup effect. All patients who received corticosteroids had a higher incidence of hyperglycemia requiring treatment in this study. Thus, in immunocompetent patients hospitalized with severe CAP, systemic corticosteroids should be considered given the possible mortality benefit of systemic corticosteroid treatment in this subgroup of patients.

Corticosteroid use should be considered for conditions that occur as a result of the aspiration event, as opposed to treatment specifically for a chemical aspiration. These would include bronchospasm, acute respiratory distress syndrome, pneumonia, and septic shock.


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