Steroids may considerably raise incident pneumonia in mechanically ventilated COVID-19 patients
Representative cases showing pneumonia extents and patterns on chest X-ray (CXR) and CT images. (A and B) A 65-year-old female with breakthrough infection 2 months after a second dose of the Pfizer vaccine (fully vaccinated). The patient had a history of hypertension. (A) CXR obtained at admission showing no abnormal opacification in both lung zones. The CXR extent of pneumonia was scored as 0 (no evidence of pneumonia). (B) Axial chest CT image at the lower lobe level (obtained on the same day) showing negatively for pneumonia; CT extent of pneumonia was scored as 0 (no evidence of pneumonia). (C and D) A 48-year-old male with 1 month after a first dose of the AstraZeneca vaccine (partially vaccinated). The patient had no history of comorbidity. (C) CXR obtained at admission showing no abnormal opacification in both lung zones. The CXR extent of pneumonia was scored as 0 (no evidence of pneumonia). (D) Axial chest CT image obtained on the same day showing unilateral ground-glass opacity with a non-rounded morphology in the left lower lobe (arrows). CT extent of pneumonia was scored as 1 (1-25% involvement) and this case was classified as indeterminate appearance of COVID-19 according to the RSNA chest CT classification system.
CREDIT
Radiological Society of North America
Acute respiratory distress syndrome (ARDS) is a common COVID-19 consequence that typically necessitates extended invasive mechanical ventilation. Since certain randomized controlled studies revealed a mortality advantage from low-dose corticosteroid therapy, early corticosteroid treatment has become common in COVID-19 patients with severe disease. Critically sick COVID-19 patients have been observed to have a significant frequency of secondary infections, especially ventilator-associated pneumonia (VAP). Uncertainty still surrounds the relationship between corticosteroids and the risk of infectious complications.
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