What are the appropriate orders for a patient diagnosed with pneumonia, experiencing hypoxemia, cough, and weakness, and can this patient be treated with corticosteroids (steroids)?

From the Guidelines

For a patient with pneumonia who is hospitalized with oxygen saturation of 90%, experiencing cough and weakness, I recommend starting empiric antibiotic therapy based on likely pathogens while awaiting culture results, and consider adding systemic corticosteroids, such as prednisone 40-50mg daily for 5-7 days or methylprednisolone 0.5-1mg/kg/day divided into 1-2 doses, to reduce inflammatory response and potentially decrease time to clinical stability, as suggested by the most recent guidelines 1.

When deciding on the use of steroids, it's essential to consider the patient's specific condition and potential contraindications, such as uncontrolled diabetes or immunocompromised states. The use of corticosteroids in patients with pneumonia has been supported by recent studies, including a multicenter RCT evaluating the effect of corticosteroids on patients with ARDS 1.

Key points to consider when managing this patient include:

• Providing supplemental oxygen to maintain O2 saturation ≥92% 1
• Considering bronchodilators for wheezing
• Ensuring adequate hydration and nutritional support
• Reassessing the patient's response to treatment within 24-48 hours to adjust therapy as needed

It's also important to note that the use of corticosteroids in patients with COVID-19-related acute hypoxemic respiratory failure has been found to reduce mortality, with a recommended dose of dexamethasone 6mg daily for up to 10 days 1. However, the patient's specific diagnosis and condition should guide the treatment approach.

In terms of specific steroid regimens, the literature suggests that prednisone 40-50mg daily for 5-7 days or methylprednisolone 0.5-1mg/kg/day divided into 1-2 doses may be beneficial for community-acquired pneumonia with hypoxemia 1. Ultimately, the decision to use steroids and the specific regimen should be individualized based on the patient's condition and potential contraindications.

From the Research

Patient Care for Pneumonia

• The patient's oxygen saturation is 90%, which is considered low and may require hospitalization 2, 3.
• According to the study by 2, oxygen saturations less than 90% are associated with increased morbidity and mortality in outpatients with pneumonia.
• The patient is complaining of cough and weakness, which are common symptoms of pneumonia.

Oxygen Therapy

• Oxygen therapy is widely used in the treatment of lung diseases, including pneumonia 4.
• Non-invasive ventilation and high-flow oxygen therapy may be effective in patients with severe community-acquired pneumonia 5.
• The study by 4 found that non-invasive ventilation can reduce the risk of death in the ICU and shorten ICU length of stay.

Use of Steroids

• The use of steroids in pneumonia therapy is still a topic of debate 6.
• Some studies have shown that steroids may have a potential harmful effect in severe pneumonia, and adverse effects such as hyperglycemia and superinfections are common 6.
• According to the current evidence, there are no data to support the use of systemic steroids as a standard of care in pneumonia, neither in mild-to-moderate and severe, nor in bacterial and viral infection 6.

Treatment Options

• The patient may require hospitalization and oxygen therapy to manage their low oxygen saturation and symptoms of pneumonia.
• Non-invasive ventilation and high-flow oxygen therapy may be considered as treatment options.
• The use of steroids should be carefully considered and individualized based on the patient's specific condition and medical history.