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Pulmonary infections in critically ill patients may cause septic shock, acute respiratory distress syndrome, or both, which are associated with mortality rates ranging between 30% and 50%.<\/jats:p><\/jats:sec><jats:sec id=\"ab-jrv240011-2\"><jats:title>Observations<\/jats:title><jats:p>Corticosteroids mitigate the immune response to infection and improve outcomes for patients with several types of severe pulmonary infections. Low-dose corticosteroids, defined as less than or equal to 400 mg hydrocortisone equivalent daily, can reduce mortality of patients with severe COVID-19, community-acquired pneumonia, and <jats:italic>Pneumocystis<\/jats:italic> pneumonia. A randomized clinical trial of 6425 patients hospitalized with COVID-19 who required supplemental oxygen or noninvasive or invasive mechanical ventilation reported that dexamethasone 6 mg daily for 10 days decreased 28-day mortality (23% vs 26%). A meta-analysis that included 7 randomized clinical trials of 1689 patients treated in the intensive care unit for severe bacterial community-acquired pneumonia reported that hydrocortisone equivalent less than or equal to 400 mg daily for 8 days or fewer was associated with lower 30-day mortality compared with placebo (10% vs 16%). In a meta-analysis of 6 randomized clinical trials, low-dose corticosteroids were associated with lower mortality rates compared with placebo for patients with HIV and moderate to severe <jats:italic>Pneumocystis<\/jats:italic> pneumonia (13% vs 25%). In a predefined subgroup analysis of a trial of low-dose steroid treatment for septic shock, patients with community-acquired pneumonia randomized to 7 days of intravenous hydrocortisone 50 mg every 6 hours and fludrocortisone 50 \u03bcg daily had decreased mortality compared with the placebo group (39% vs 51%). For patients with acute respiratory distress syndrome caused by various conditions, low-dose corticosteroids were associated with decreased in-hospital mortality (34% vs 45%) according to a meta-analysis of 8 studies that included 1091 patients. Adverse effects of low-dose corticosteroids may include hyperglycemia, gastrointestinal bleeding, neuropsychiatric disorders, muscle weakness, hypernatremia, and secondary infections.<\/jats:p><\/jats:sec><jats:sec id=\"ab-jrv240011-3\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>Treatment with low-dose corticosteroids is associated with decreased mortality for patients with severe COVID-19 infection, severe community-acquired bacterial pneumonia, and moderate to severe <jats:italic>Pneumocystis<\/jats:italic> pneumonia (for patients with HIV). Low-dose corticosteroids may also benefit critically ill patients with respiratory infections who have septic shock, acute respiratory distress syndrome, or both.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jama.2024.6096","type":"journal-article","created":{"date-parts":[[2024,6,12]],"date-time":"2024-06-12T15:01:01Z","timestamp":1718204461000},"page":"318","source":"Crossref","is-referenced-by-count":67,"title":["Low-Dose Corticosteroids for Critically Ill Adults With Severe Pulmonary Infections"],"prefix":"10.1001","volume":"332","author":[{"given":"Romain","family":"Pirracchio","sequence":"first","affiliation":[{"name":"Department of Anesthesia and Perioperative Medicine, University of California San Francisco"},{"name":"Associate Editor, JAMA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Balasubramanian","family":"Venkatesh","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of New South Wales Sydney, 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