Effect of corticosteroids on adult varicella pneumonia: Cohort study and literature review

Background:  Varicella pneumonia (VP) is a serious entity associated with morbidity and mortality. There have been sporadic reports using corticosteroids in life-threatening VP. We report a case series of VP to examine the outcome and the effect of corticosteroid use. Methods:  A retrospective chart review was conducted on all adult patients admitted to a tertiary care hospital with VP during a 14-year period. We documented oxygenation (SpO2, PaO2/FIO2) on admission and after 48 h, whether the patients were admitted to an intensive care unit (ICU), the use of mechanical ventilation, ICU and hospital length of stay (LOS) and patient outcome. We compared those patients who received corticosteroids with those who did not. Results:  We identified 19 patients with VP. Ten received corticosteroids, in addition to antiviral and supportive treatment. Patients who received corticosteroids were significantly more hypoxaemic on admission and all were admitted to ICU with seven of them intubated. Only two of the nine in non-steroid group were intubated. Despite their greater severity, the corticosteroid group showed a much more rapid improvement in oxygenation and a trend towards shorter duration of mechanical ventilation. The duration of ICU and hospital LOS were not significantly different. All patients survived. Conclusions:  Corticosteroids in severe VP accelerate the physiological recovery and may shorten the duration of mechanical ventilation.