Corticosteroids Harmful to ICU Patients

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Corticosteroids Harmful to ICU Patients

(Ivanhoe Newswire) -- Patients who receive corticosteroids in the trauma intensive care unit may have more infections, stay in the ICU longer and have a higher risk of death.
Researchers from Eastern Virginia Medical School in Norfolk compared the records of 100 patients who received corticosteroids in the trauma-burn ICU at Sentara Norfolk General Hospital bto 100 patients who did not receive the drugs.
Results show more patients in the corticosteroid group than those in the control group developed pneumonia -- 26 percent vs. 12 percent, bloodstream infections -- 19 percent vs. 7 percent, andurinary tract infection -- 17 percent vs. 8 percent. Patients taking the drugs were hospitalized in the ICU seven days longer -- 17.6 vs. 10.2 days and were on a ventilator five additional days -- 9.9 vs. 4.9 days. They were also more likely to die.
Investigators found many patients were taking corticosteroids for conditions not widely studied. In fact, 39 of the 100 received the medication for reasons supported by research.
"The remaining 61 should not have received corticosteroids based on a strict interpretation of the current literature," study authors say. "Certainly, the risk of infection outweighs the potential benefit in these cases."
Corticosteroids are used in the ICU to treat a variety of conditions, including sepsis, swelling of the airway, and spinal cord injury. While they are effective, researchers say the drugs can suppress the immune system and make the patient more prone to infections and other complications.
Researchers say the indications, risks and benefits of corticosteroids must be considered with caution.

http://www.ivanhoe.com/channels/p_ch...?storyid=13161

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Steroids in ICU May Do More Harm than Good
By Neil Osterweil , MedPage Today Staff Writer
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.

MedPage Today Action Points

• Understand that this study suggests that the use of corticosteroids in ICU patients appears to be associated with a greater risk for pneumonia, bacteremia, and other infections, greater length of stay, and longer time on respiratory support.
• This study also suggests that indications for the use of steroids in the ICU should be carefully reviewed with risks often outweighing potential benefits.

http://www.medpagetoday.com/Endocrin...eroids/tb/2712


Review
NORFOLK, Va., Feb. 20 - Patients in intensive care who are treated with corticosteroids have an increased infection rate, longer ICU stays, spend more time on ventilators, and may be at greater risk of death, reported researchers here.

In a case-control study comparing 100 patients who received corticosteroids in a burn-trauma ICU, the investigators found that patients who received the drugs stayed a week longer in the ICU, remained on ventilators five days longer, and had higher rates of pneumonia, bacteremia, and urinary tract infections, reported Rebecca C. Britt, M.D. and colleagues of the Eastern Virginia Medical School here and the University of Wisconsin in Madison.
"Caution must be taken to carefully consider the indications, risks, and benefits of corticosteroids when deciding on their use [in the ICU]," they wrote in the Feb. 20 issue of the Archives of Surgery.

In an accompanying invited critique, Michael F. Rotondo, M.D., and Paul J. Schenarts, M.D., of East Carolina University in Greenville, N.C., said the authors "have clearly articulated the results of a well-designed case-control study examining the complications associated with steroid use in the ICU. Their findings of significantly increased rates of pneumonia, bloodstream infections, urinary tract infections, ventilator days, and ICU length of stay serve as a warning to those who advocate increased steroid use."

They added, "It is also noteworthy that these results may have been even more significant, had their institution not already implemented a series of protocols designed to limit infections."

Dr. Britt and colleagues conducted a case-control study of data on 100 patients who received corticosteroids in a burn-trauma ICU in a level 1 trauma center. The patients were matched by age and injury severity score with controls who were treated in the same ICU but without corticosteroids.

The cases and controls had similar Acute Physiology and Chronic Health Evaluation II (APACHE II) scores and medical history.

The investigators looked at seven outcomes: pneumonia, bloodstream infections, urinary tract infection, other infections, ICU length of stay, ventilator length of stay, and death.
Looking at single variables, they found that the patients who received corticosteroids had significant increases in pneumonia (26% vs 12%; P<0.01), bloodstream infections (19% vs 7%; P<0.01), and urinary tract infections (17% vs 8%, P<0.05).

[SCI-Nurse]

This is not new news. We have known this for many, many years. The risks for increased infection, in SCI, are outweighed by the chance that high dose steriods initially after injury may increase incompleteness.

(KLD)