CORTICOSTEROIDS IN LIFE-THREATENING VARICELLA PNEUMONIA

Background: Varicella pneumonia that results in respiratory failure or progresses to the institution of mechanical ventilation carries a sig nificant morbidity and mortality despite intensive respiratory support and antiviral therapy, There has been no reported study of the role o f corticosteroids in life-threatening varicella pneumonia, Design and methods: This was an uncontrolled retrospective and prospective study of all adult patients with a diagnosis of varicella pneumonia who were admitted to the ICUs of the Johannesburg group of academic hospitals in South Africa between 1980 and 1996, Patient demographies, clinical and laboratory features, necessity for mechanical ventilation, and com plications were reviewed. The outcome and therapy off varicella pneumo nia was evaluated with particular reference to the use of corticostero ids, Patients with comorbid disease and those already taking immunosup pressive agents were excluded, Key endpoints included length of ICU an d hospital stay and mortality. Measurements and results: Fifteen adult patients were evaluated, six of whom received corticosteroids ire add ition to antiviral and supportive therapy, These six patients demonstr ated a clinically significant therapeutic response. They had significa ntly shorter hospital (median difference, 10 days; p<0.006) and ICU (m edian difference, 8 days; p=0.008) stays and there was no mortality, d espite the fact that they were admitted to the ICU with significantly Bower median ratios between PaO2 and fraction of inspired oxygen than those patients (n=9) who did not receive corticosteroid therapy (86.5 vs 129.5; p=0.045). Conclusion: When used in addition to appropriate s upportive care and early institution of antiviral therapy, corticoster oids appear to be of value in die treatment of previously well patient s with life-threatening varicella pneumonia. The observations presente d in this study are important and should form the basis for a randomiz ed controlled trial, as no other relevant studies or guidelines are av ailable.