الفهرس 
PneumoniaOnly 14 pages are availabe for public view
Abstract
Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. Despite the developments in antibiotic therapy, no substantial progress has been made in the last decades. Additional therapeutic interventions along with antibiotics may help to improve outcome in patients with CAP.
Corticosteroids in CAP might be effective in reducing excess systemic and pulmonary inflammation, which might translate to improved outcome. Glucocorticoids, the most important natural inhibitors of inflammation, are not always effective in suppressing life-threatening systemic inflammation. The presence of systemic inflammation induced tissue resistance to glucocorticoids and/or inadequate adrenal output might explain why older clinical trials found no efficacy with a time-limited course of massive doses of glucocorticoids. The standard treatment of CAP has not changed for the past 50 years, and its mortality and morbidity has remained high at 5 to 15% despite the availability of broad-spectrum antibiotics.
we assessed the efficacy of low dose hydrocortisone Infusion in severe community-acquired pneumonia. The current study was conducted on 70 patients, attending Ain Shams University Hospital, with clinical or radiological findings of community-acquired pneumonia, they were assessed clinically, radiologically and haematologically.
These hospitalized patients were classified into 2 groups:
1- Control group included 35 patients with community acquired pneumonia receiving a placebo infusion (control group).
2- Intervention group included 35 patients with community acquired pneumonia randomly receiving 200 mg hydrocortisone (2 hydrocortisone vials, 200 mg / 4 ml) intravenously for 7 days (intervention group).
In our study, there is statistically non-significant difference between the studied groups regarding age or gender. Males were higher in distribution study groups as they represent 80% of cases of hydrocortisone group, while males represent 74.3% of placebo group.
In the current study, there are statistically non-significant differences between the studied groups regarding respiratory rate, HCO3, SpO2, CRP and GCS at the first day. On the other hand, there are significant differences between both groups regarding respiratory rate, HCO3, SpO2, CRP and GCS on third and seventh day. On measuring change over time in each group, there are significant fluctuations in respiratory rate, HCO3, SpO2, CRP and GCS over time. But, there are statistically non-significant differences between the studied groups regarding pulse, systolic blood pressure, pH, PCO2 and TLC at the first day and third day. On the other hand, there are significant differences between both groups regarding pulse, systolic blood pressure, pH, PCO2 and TLC on the seventh day. On measuring change over time in each group, there are significant changes in pulse, systolic blood pressure and TLC over time and there is significant increase in pH and PCO2 over time in the hydrocortisone group, while there are non-significant changes in pH and PCO2 in placebo group.
In our study, there is statistically non-significant difference between the studied groups regarding diastolic blood pressure at the first, third or seventh day. On measuring change over time in each group, there is significant fluctuation in diastolic blood pressure over time.
There are statistically non-significant differences between the studied groups regarding temperature, random blood sugar and serum creatinine at the first, third or seventh day. On measuring change over time in each group, there are significant fluctuations in temperature, random blood sugar and serum creatinine over time.
In our study, there are non-significant differences between the studied groups regarding presence of comorbid renal disease, CVS, congestive heart failure, liver disease, presence of ground glass appearance, consolidation, pH and HCO3. However, there are a significant difference between them regarding presence of pleural effusion on first day and a non-significant difference between them regarding pleural effusion on 7th day. Also, there are significant differences between the studied groups regarding percent change in respiratory rate, pulse, systolic, diastolic blood pressure, temperature, GCS, PCO2, PCO2, C-reactive protein, total leucocytic count, random blood sugar and serum creatinine.