ISICEM and steroids in severe pneumonia

ISICEM has begun – lots of interesting papers being presented, can follow on Twitter with #ISICEM23 [https://twitter.com/hashtag/ISICEM23?src=hashtag_click].

Some studies of high interest: anticoagulation for COVID, ravulizumab for COVID, feeding in shock, and more:  https://twitter.com/tscquizzato/status/1638128616713101313

And of special interest – CAPE COD – are steroids back in for severe pneumonia? Out in NEJM today: https://www.nejm.org/doi/full/10.1056/NEJMoa2215145?query=featured_home

TL;DR – 800 patients with severe pneumonia admitted to the ICU randomized to 200mg daily hydrocortisone vs placebo; reduced mortality (6.2% vs 11.9%), higher ICU discharge, less intubation (18% vs 29.5%)! Note those with septic shock were excluded (probably because they would receive hydrocort 50q6 anyway?).

Especially beneficial in subgroup with high CRP (makes sense)

Farkas already has his take up here: https://emcrit.org/pulmcrit/cape-cod/