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Tratamiento con glucocorticoides en la neumonía adquirida en el hospital y asociada al ventilador

Cecile Poulain¹, Marwan Bouras², Antoine Roquilly¹

¹Nantes Universite, Nantes, France.

Seminars in respiratory and critical care medicine

|September 3, 2025

Resumen

Los glucocorticoides son prometedores como terapia complementaria para la neumonía adquirida en el hospital (PAH) y la neumonía asociada al ventilador (PAV) al reducir la inflamación. Se necesita más investigación para personalizar su uso en pacientes críticos para mejorar los resultados.

Área de la Ciencia:

Medicina de cuidados intensivos
Pulmonología
Inmunología

Sus antecedentes:

La neumonía adquirida en el hospital (HAP) y la neumonía asociada al ventilador (VAP) son complicaciones frecuentes en pacientes en estado crítico.
Los tratamientos actuales, incluidos los antibióticos, tienen altas tasas de incidencia y fracaso del tratamiento.
Actualmente no existe una terapia complementaria estándar para la PAH y la PAV.

Objetivo del estudio:

Explorar el potencial de los glucocorticoides como terapia adyuvante inmunomoduladora para la PAH y la PAV.
Revisar la evidencia existente y la investigación en curso sobre el uso de corticosteroides en estas condiciones.
Discutir enfoques personalizados para optimizar el tratamiento con corticosteroides en PAH y PAV.

Principales métodos:

Revisión de la literatura existente y hallazgos de afecciones respiratorias relacionadas.
Análisis de los datos preliminares de los ensayos de prevención en pacientes con trauma.
Discusión de los ensayos controlados aleatorios en curso para el tratamiento adyuvante.

Principales resultados:

Los glucocorticoides pueden reducir la lesión pulmonar y mejorar los resultados al modular la inflamación excesiva.
La evidencia en HAP y VAP es limitada, pero los estudios en condiciones relacionadas (por ejemplo, ARDS, COVID-19) muestran beneficios potenciales.
Los enfoques guiados por biomarcadores y los ensayos en curso están investigando la selección de pacientes para el tratamiento con corticosteroides.

Conclusiones:

Los glucocorticoides son una estrategia complementaria prometedora para la PAH y la PAV, respaldada por sus efectos antiinflamatorios.
Los enfoques de la medicina personalizada, utilizando biomarcadores inflamatorios y considerando el microbioma pulmonar, son cruciales para optimizar la eficacia.
Es esencial realizar más investigaciones para perfeccionar la selección de pacientes y las estrategias de tratamiento para estas infecciones.

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