Nedel Wagner Luis, Nora David Garcia, Salluh Jorge Ibrain Figueira, Lisboa Thiago, Póvoa Pedro
Wagner Luis Nedel, Intensive Care Unit, Hospital Nossa Senhora da Conceição, Porto Alegre, RS 91350-200, Brazil.
World J Crit Care Med. 2016 Feb 4;5(1):89-95. doi: 10.5492/wjccm.v5.i1.89.
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.
流感肺炎与大量需要住院及入住重症监护病房（ICU）的重症病例相关，死亡率很高。尽管全身用类固醇的效果仍存在争议，但它被认为是一种有效的治疗选择。已发表数据在研究设计、人群特征、疾病严重程度、给药剂量、所使用皮质类固醇的类型和时间方面存在异质性，这构成了得出有力结论的重要限制。然而，有理由承认，由于在如此多样的情况下未发现皮质类固醇治疗有任何优势，所以这种有益效果根本不存在。其使用可能会增加总体死亡率，无论研究的质量和样本量如何，这种趋势都是一致的。此外，研究表明皮质类固醇可能与医院获得性肺炎的发生率较高、机械通气时间延长和ICU住院时间延长有关。最后，可以合理地得出结论，皮质类固醇在治疗重症流感感染患者方面未能显示出任何有益效果。因此，目前其在重症流感肺炎中的使用应仅限于经过严格挑选的病例以及临床试验环境中。
