Table 1.
Inclusion and exclusion criteria
| Inclusion criteria | Patients 18 yr or older with |
| 1. Severe pneumonia defined as hospitalization for acute (<7 d) onset of symptoms (cough, sputum production, or dyspnea) and radiographic evidence of pneumonia by chest radiograph or CT scan AND evidence of systemic inflammation (temperature of <35°C or >38°C OR WBC < 4,000 or >11,000 OR procalcitonin > 0.5 μg/L) | |
| AND | |
| 2. Hypoxemia defined as new requirement for supplemental oxygen with SpO2 < 92% on room air, ≤96% on ≥2 L/min of oxygen, or >6 L/min or NIV regardless of SpO2 at enrollment. Patients admitted with pneumonia but not meeting criteria for hypoxemia will be followed for up to 24 h from emergency department admission to assess for development of qualifying hypoxemia. | |
| Exclusion criteria | • Confirmed COVID-19 infection |
| • Inability to obtain consent within 24 h of presentation to emergency room | |
| • Intubation (or impending intubation) before enrollment | |
| Patients receiving HFNC oxygen or NIV before enrollment are not excluded. | |
| • A condition requiring inhaled corticosteroids or β-agonists or chronic systemic steroid therapy equivalent to a dose >10 mg of prednisone (Patients receiving inhaled β-agonists in the emergency department without an established indication will be eligible if treating clinician is willing to discontinue subsequent treatments.) | |
| • Do-not-intubate order but does not include a “do-not-resuscitate” order | |
| • Chronic lung or neuromuscular disease requiring daytime oxygen or mechanical ventilation other than for OSA or obesity hypoventilation syndrome | |
| • Not anticipated to survive >48 h or not expected to require >48 h of hospitalization | |
| • Contraindication or allergy to corticosteroids or β-agonists | |
| • Patients with heart rate >130 bpm, ventricular tachycardia, or new SVT within last 4 h (potentially eligible for enrollment after the condition has resolved) | |
| • Patients with K+ < 3.0 mmol/L (potentially eligible for enrollment after the condition has resolved) | |
| • Pregnancy | |
| • Incarcerated individual | |
| • Physician refusal of consent to protocol | |
| • Patient/surrogate refusal of consent to protocol |
Definition of abbreviations: bpm = beats per minute; COVID-19 = coronavirus disease; CT = computed tomography; HFNC = high-flow nasal cannula; NIV = noninvasive ventilation; OSA = obstructive sleep apnea; SpO2 = oxygen saturation as measured by pulse oximetry; SVT = supraventricular tachycardia; WBC = white blood cell count.