***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To determine the efficacy of dexamethasone in the treatment of mechanically ventilated children with respiratory syncytial virus – severe lower respiratory tract infection . Design : International , multicenter , r and omized , double-blind , placebo-controlled trial . Setting : Twelve pediatric intensive care units . Subjects : Children ( < 2 yrs ) mechanically ventilated for respiratory syncytial virus lower respiratory tract infection . Children were prestratified for severity of oxygen abnormalities on admission . Intervention : Intravenous dexamethasone ( 0.6 mg/kg/day , 48 hrs ) or placebo . Measurements and Main Results : A superiority approach was used in the subgroup of patients with mild oxygen abnormalities ( arterial partial pressure of oxygen/fractional inspired oxygen concentration [ PaO2/Fio2 ] > 200 mm Hg and /or mean arterial pressure ≤10 cm H2O ) and a noninferiority approach in those with severe oxygen abnormalities ( PaO2/Fio2 ≤200 mm Hg and mean arterial pressure > 10 cm H2O ) . Primary outcome was the duration of mechanical ventilation . In the subgroup with mild oxygenation abnormalities , 45 of the 89 included patients received dexamethasone and 44 placebo ; in the subgroup with severe oxygenation abnormalities , 28 of the 56 included patients received dexamethasone and 28 placebo . Baseline characteristics in both treatment arms were similar for both subgroups . After the third interim analysis , the trial was stopped early for futility taking the slow enrollment into account . At that time , the median duration ( interquartile range ) of mechanical ventilation was 137 ( 91–195 ) hrs in the dexamethasone- and 139 ( 117–188 ) hrs in the placebo-treated patients in the subgroup with mild oxygenation abnormalities ( p = .6 ) . In the subgroup with severe oxygenation abnormalities , it was 171 ( 136–212 ) hrs in the dexamethasone- and 170 ( 125–201 ) hrs in the placebo-treated patients ( p = .6 ) . Conclusion : In this prematurely ended trial in children mechanically ventilated for severe respiratory syncytial virus – lower respiratory tract infection , we found no evidence of a beneficial effect of dexamethasone in children with mild oxygenation abnormalities . Neither was evidence found that dexamethasone may prolong mechanical ventilation in those with severe oxygenation abnormalities Introduction The benefit of corticosteroids as adjunctive treatment in patients with severe community-acquired pneumonia ( CAP ) requiring hospital admission remains unclear . This study aim ed to evaluate the impact of corticosteroid treatment on outcomes in patients with CAP . Methods This was a prospect i ve , double-blind and r and omized study . All patients received treatment with ceftriaxone plus levofloxacin and methyl-prednisolone ( MPDN ) administered r and omly and blindly as an initial bolus , followed by a tapering regimen , or placebo . Results Of the 56 patients included in the study , 28 ( 50 % ) were treated with concomitant corticosteroids . Patients included in the MPDN group show a more favourable evolution of the pO2/FiO2 ratio and faster decrease of fever , as well as greater radiological improvement at seven days . The time to resolution of morbidity was also significantly shorter in this group . Six patients met the criteria for mechanical ventilation ( MV ) : five in the placebo group ( 22.7 % ) and one in the MPDN group ( 4.3 % ) . The duration of MV was 13 days ( interquartile range 7 to 26 days ) for the placebo group and three days for the only case in the MPDN group . The differences did not reach statistical significance . Interleukin (IL)-6 and C-reactive protein ( CRP ) showed a significantly quicker decrease after 24 h of treatment among patients treated with MPDN . No differences in mortality were found among groups . Conclusions MPDN treatment , in combination with antibiotics , improves respiratory failure and accelerates the timing of clinical resolution of severe CAP needing hospital admission . Trial Registration International St and ard R and omized Controlled Trials Register , IS RCT N22426306 Community-acquired pneumonia occurs 3 to 4 million times per year in the United States , accounting for about 500,000 hospitalizations annually . Empiric treatment is usually instituted because of a lack of early organism-specific diagnostic tests . This study compared empiric therapy with ofloxacin to st and ard antibiotic regimens ( usually a beta-lactam with or without a macrolide ) for patients hospitalized for community-acquired pneumonia . Therapy was administered to 298 patients ( 146 receiving ofloxacin and 152 receiving st and ard therapy ) ; 227 patients ( ofloxacin , 109 ; st and ard treatment , 118 ) were evaluable for treatment efficacy . The most common pyogenic respiratory pathogens were Haemophilus influenzae ( 30 isolates ) and Streptococcus pneumoniae ( 24 isolates ) . There was evidence of infection with either Mycoplasma pneumoniae ( 38 patients ) , Chlamydia pneumoniae ( 40 patients ) , or a Legionella sp. ( 8 patients ) in a total of 79 patients ( 35 % ) . The clinical success rates were similar in both groups among evaluable patients ( 92 % , ofloxacin ; 87 % , st and ard therapy ) and among patients with atypical respiratory pathogens ( 88 % , ofloxacin ; 81 % , st and ard therapy ) . The mean numbers ( + /- the st and ard deviations ) of intravenous doses of antibiotics were 7.5 + /- 8.0 in the ofloxacin group and 18.4 + /- 18.5 in the st and ard therapy group ( P < 0.001 ) ; the mean number of oral doses of ofloxacin per patient was 19.7 + /- 11.2 , compared with 30.2 + /- 16.0 oral antibiotic doses in the st and ard therapy group ( P < 0.001 ) . All treatments were well tolerated and associated with no significant clinical or laboratory abnormalities . The findings of this study indicate that ofloxacin is active against traditional bacterial pathogens as well as the major atypical respiratory pathogens . When given as monotherapy for the empiric treatment of community-acquired pneumonia , ofloxacin is as effective as st and ard antimicrobial therapy Objective : To develop consensus statements for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients . Participants : A multidisciplinary , multispecialty task force of experts in critical care medicine was convened from the membership of the Society of Critical Care Medicine and the European Society of Intensive Care Medicine . In addition , international experts in endocrinology were invited to participate . Design / Methods : The task force members review ed published literature and provided expert opinion from which the consensus was derived . The consensus statements were developed using a modified Delphi methodology . The strength of each recommendation was quantified using the Modified GRADE system , which classifies recommendations as strong ( grade 1 ) or weak ( grade 2 ) and the quality of evidence as high ( grade A ) , moderate ( grade B ) , or low ( grade C ) based on factors that include the study design , the consistency of the results , and the directness of the evidence . Results : The task force coined the term critical illness – related corticosteroid insufficiency to describe the dysfunction of the hypothalamic-pituitary-adrenal axis that occurs during critical illness . Critical illness – related corticosteroid insufficiency is caused by adrenal insufficiency together with tissue corticosteroid resistance and is characterized by an exaggerated and protracted proinflammatory response . Critical illness – related corticosteroid insufficiency should be suspected in hypotensive patients who have responded poorly to fluids and vasopressor agents , particularly in the setting of sepsis . At this time , the diagnosis of tissue corticosteroid resistance remains problematic . Adrenal insufficiency in critically ill patients is best made by a delta total serum cortisol of < 9 & mgr;g/dL after adrenocorticotrophic hormone ( 250 & mgr;g ) administration or a r and om total cortisol of < 10 & mgr;g/dL. The benefit of treatment with glucocorticoids at this time seems to be limited to patients with vasopressor-dependent septic shock and patients with early severe acute respiratory distress syndrome ( Pao2/Fio2 of < 200 and within 14 days of onset ) . The adrenocorticotrophic hormone stimulation test should not be used to identify those patients with septic shock or acute respiratory distress syndrome who should receive glucocorticoids . Hydrocortisone in a dose of 200 mg/day in four divided doses or as a continuous infusion in a dose of 240 mg/day ( 10 mg/hr ) for ≥7 days is recommended for septic shock . Methylprednisolone in a dose of 1 mg·kg−1·day−1 for ≥14 days is recommended in patients with severe early acute respiratory distress syndrome . Glucocorticoids should be weaned and not stopped abruptly . Reinstitution of treatment should be considered with recurrence of signs of sepsis , hypotension , or worsening oxygenation .  Dexamethasone is not recommended to treat critical illness – related corticosteroid insufficiency . The role of glucocorticoids in the management of patients with community-acquired pneumonia , liver failure , pancreatitis , those undergoing cardiac surgery , and other groups of critically ill patients requires further investigation . Conclusion : Evidence -linked consensus statements with regard to the diagnosis and management of corticosteroid deficiency in critically ill patients have been developed by a multidisciplinary , multispecialty task force BACKGROUND The reliability of chest physical examination and the degree of agreement among examiners in diagnosing pneumonia based on these findings are largely unknown . OBJECTIVES To determine the accuracy of various physical examination maneuvers in diagnosing pneumonia and to compare the interobserver reliability of the maneuvers among 3 examiners . METHODS Fifty-two male patients presenting to the emergency department of a university-affiliated Veterans Affairs medical center with symptoms of lower respiratory tract infection ( cough and change in sputum ) were prospect ively examined . A comprehensive lung physical examination was performed sequentially by 3 physicians who were blind to clinical history , laboratory findings , and x-ray results . Examination findings by lung site and whether the examiner diagnosed pneumonia were recorded on a st and ard form . Chest x-ray films were read by a radiologist . RESULTS Twenty-four patients had pneumonia confirmed by chest x-ray films . Twenty-eight patients did not have pneumonia . Abnormal lung sounds were common in both groups ; the most frequently detected were rales in the upright seated position and bronchial breath sounds . Relatively high agreement among examiners ( kappa approximately 0.5 ) occurred for rales in the lateral decubitus position and for wheezes . The 3 examiners ' clinical diagnosis of pneumonia had a sensitivity of 47 % to 69 % and specificity of 58 % to 75 % . CONCLUSIONS The degree of interobserver agreement was highly variable for different physical examination findings . The most valuable examination maneuvers in detecting pneumonia were unilateral rales and rales in the lateral decubitus position . The traditional chest physical examination is not sufficiently accurate on its own to confirm or exclude the diagnosis of pneumonia Background Recent studies suggested that administration of corticosteroids may improve clinical outcomes in patients with severe pneumonia . Objectives The aim of this study was to assess the effectiveness of corticosteroids as an adjunctive therapy in community-acquired pneumonia ( CAP ) requiring hospitalization . Design and Setting An open label , prospect i ve , r and omized control study was conducted from September 2003 to February 2004 in a community general hospital in Japan . Patients Thirty-one adult CAP patients who required hospitalization were enrolled . Measurements and Results Fifteen patients received 40 mg of prednisolone intravenously for 3 days ( steroid group ) . Sixteen patients did not receive prednisolone ( control group ) . Both groups were also evaluated for their adrenal function . The primary endpoint was length of hospital stay . Secondary endpoints were duration of intravenous ( IV ) antibiotics and time required to stabilize vital signs . Both groups demonstrated similar baseline characteristics and length of hospital stay , and yet a shorter duration of IV antibiotics was observed in the steroid group ( p < 0.05 ) . In addition , vital signs were stabilized earlier in the steroid group ( p < 0.05 ) . These differences were more prominent in the moderate – severe subgroup but not as significant in the mild – moderate subgroup . The prevalence of relative adrenal insufficiency ( RAI ) in both groups was high ( 43 % ) , yet there was no difference in baseline characteristics between patients , with or without RAI . In multiple regression models , RAI seemed to have no influence on clinical courses . Conclusions In moderate – severe CAP , administration of corticosteroids promotes resolution of clinical symptoms and reduces the duration of intravenous antibiotic therapy Context Bloodstream infections are traditionally classified as community-acquired or hospital 
    Output:
    
Corticosteroid therapy reduced morbidity , but not mortality , for adults and children with non-severe CAP .
Corticosteroid therapy was associated with more adverse events , especially hyperglycaemia , but the harms did not seem to outweigh the benefits