Thats an interesting question

Steroids have a proven role in certain pneumonias like Pneumocystis Jerovicii in HIV where they have shown beneficial effect in those with severe hypoxemia.

It is also well known that steroids have a role sepsis with mortality benefit, esp when shock sets in. Considering that Pneumonia is one of the commonest causes of sepsis, it stands to reason that some benefit may be accrued in this situation too.

The studies so far (8 of them) have been underpowered. However there is a large RCT that might have adequate power to resolve this issue whose results are expected in 2018. 

Till then, the best that can be said is that it looks promising.

regards

I think because of heterogenity of causative agents and different pathophysiology in different types of pneumonia, there could not be any net suggestion to give steroids even in severe pneumonia. We need to know more about concerete panthophysiology of given patient - e.g. some biomarkers - to have information about how does the immune system work in concrete patient. Without this data I do not give steroids because for me infection=no steroids unless I find some contribution of some autoimmunity or autodestructive process.

That is right, but the patient has to survive the first hit (infection) and then the fibrosis has time to evolve. My opinion : in first hours or days there is no place for steroids without strong evidence of ongoing autodestructive process like e.g. in hepatitis, where the immune answer kills the hepatic cells, not the virus itself.

Thanks for your comments, very interesting. I will await the results of this study..

Just a point to add (from experience with ventillated pediatric patients):

Even in the setting of Pneumonia with ARDS intensive care units often use steroids due to the reason as Dr. Shankar has very rightly mentioned that it decreases hypoxemia and as Dr. Olena has correctly said that somewhat halts the immunological pathways leading to permanent lung damage and prolonged ventilator dependency.