Does low-dose hydrocortisone therapy prevent ventilator-associated pneumonia in trauma patients?

The incidence of ventilator-associated pneumonia (VAP) is particularly high in trauma patients. Immediate acute inflammation response is one of the hallmarks of multiple trauma. This phenomenon is associated with an immunosuppression state and may increase the risk of VAP. In our study, we aimed to evaluate whether low-dose steroids prevent VAP onset in multiple trauma patients. All adult patients admitted in our intensive care unit (ICU) for multiple trauma with predicted duration of mechanical ventilation over 48 hours were included. We compared 2 different periods: a retrospective cohort of patients who did not receive low-dose steroids for VAP prevention and a prospective cohort of patients who received hydrocortisone with a dose of 100 mg/8 hours for a scheduled period of 7 days. We included 175 patients: 92 in the steroids (-) group and 83 in the steroids (+) group. The incidence of VAP was not different between the 2 studied groups (29.3% and 26.5%; P = 0.676). When predictive factors of VAP onset were studied in multivariate analysis, steroids had no preventive effect on VAP [OR = 1.6; 95% confidence interval, 0.73-3.6; P = 0.234]. We did not find any difference between the 2 groups, neither in terms of ICU length of stay (respectively, 11 ± 9.7 days vs. 12.3 ± 10.7 days; P = 0.372) nor in terms of ICU mortality (29.3% vs 24.1%; P = 0.434).