[show abstract][hide abstract] ABSTRACT: The benefit of corticosteroids as adjunctive treatment in patients with severe community-acquired pneumonia (CAP) requiring hospital admission remains unclear. This study aimed to evaluate the impact of corticosteroid treatment on outcomes in patients with CAP.
This was a prospective, double-blind and randomized study. All patients received treatment with ceftriaxone plus levofloxacin and methyl-prednisolone (MPDN) administered randomly and blindly as an initial bolus, followed by a tapering regimen, or placebo.
Of the 56 patients included in the study, 28 (50%) were treated with concomitant corticosteroids. Patients included in the MPDN group show a more favourable evolution of the pO2/FiO2 ratio and faster decrease of fever, as well as greater radiological improvement at seven days. The time to resolution of morbidity was also significantly shorter in this group. Six patients met the criteria for mechanical ventilation (MV): five in the placebo group (22.7%) and one in the MPDN group (4.3%). The duration of MV was 13 days (interquartile range 7 to 26 days) for the placebo group and three days for the only case in the MPDN group. The differences did not reach statistical significance. Interleukin (IL)-6 and C-reactive protein (CRP) showed a significantly quicker decrease after 24 h of treatment among patients treated with MPDN. No differences in mortality were found among groups.
MPDN treatment, in combination with antibiotics, improves respiratory failure and accelerates the timing of clinical resolution of severe CAP needing hospital admission.
International Standard Randomized Controlled Trials Register, ISRCTN22426306.
Critical care (London, England) 03/2011; 15(2):R96. · 4.72 Impact Factor
[show abstract][hide abstract] ABSTRACT: The aim of this study was to compare the evolution of systemic cytokine levels over time in patients with pneumococal pneumonia treated either with β-lactam monotherapy or with combination therapy (β-lactam plus fluoroquinolone). Prospective observational study of hospitalized non-immunocompromised adults with PP. Concentrations of IL-6, IL-8, IL-10, and TNF-α were determined on days 0, 1, 2, 3, 5, and 7. Patients on β-lactam monotherapy were compared with those receiving combination therapy. Fifty-two patients were enrolled in the study. Concentrations of IL-6, IL-8, and IL-10 decreased rapidly in the first days after admission, in accordance with the mean time to defervescence. High levels of IL-6 were found in patients with the worst outcomes, measured by the need for intensive care unit admission and mortality. No major differences in demographic or clinical characteristics or severity of disease were found between patients treated with β-lactam monotherapy and those treated with combination therapy. IL-6 levels fell more rapidly in patients with combination therapy in the first 48 h (p = 0.016). Our data suggest that systemic expression of IL-6 production in patients with PP correlates with prognosis. Initial combination antibiotic therapy produces a faster decrease in this cytokine in the first 48 h.
European Journal of Clinical Microbiology 10/2010; 29(10):1243-51. · 3.02 Impact Factor
[show abstract][hide abstract] ABSTRACT: A 48-year-old smoker and alcoholic patient was admitted for life-threatening hemoptysis. The admission bronchoscopy showed a tumoral mass almost occluding the right bronchus intermedious. During the procedure the patient developed massive bleeding and underwent selective aortic angiogram and coiling of 2 bronchial arteries. After the patient stabilized, a contrast thoracic computed tomography was performed, revealing a right pulmonary artery pseudoaneurysm. On the basis of that finding, a selective right pulmonary artery angiogram was performed, showing a 3.4-cm-diameter pseudoaneurysm that was embolized. Hemoptysis resolved after the procedure, but the patient developed parenchymal ischemia-infarct on the treated area (right lower lobe). A pulmonary artery pseudoaneurysm can arise from a lung tumor and cause massive hemoptysis. Although unusual, ischemia and infarct can occur after embolotherapy.
Journal of bronchology & interventional pulmonology. 10/2009; 16(4):274-6.
[show abstract][hide abstract] ABSTRACT: Endobronchial ultrasound (EBUS) is a minimally invasive staging method that has emerged as a potential alternative to mediastinoscopy in lung cancer staging. The radial probe EBUS was initially developed in the 1990s and demonstrated to be a technique with a higher diagnostic yield than conventional blind transbronchial needle aspiration, with a pooled sensitivity of 78%. The new EBUS-guided fine needle aspiration (EBUS-FNA) is a real-time ultrasonographically visualized puncture that achieves a sensitivity of 92.5%, a negative predictive value of 91% and a diagnostic accuracy of 95% on average. Lymph nodes down to 5 mm can be successfully sampled and there are no reports of major complications. The combination of EBUS-FNA and transesophageal ultrasound FNA (EUS-FNA) provides complementary and near global staging of the mediastinum, covering more lymph node stations than mediastinoscopy alone. A potential lung cancer algorithm of the future would use endoscopic minimally invasive approaches and restrict diagnostic surgical procedures to negative needle cytology results.
Clinical Pulmonary Medicine 08/2009; 16(5):275-280.