Background: Evidence supporting corticosteroids adjunctive treatment (CAT) for Pneumocystis jirovecii pneumonia (PCP) in non-HIV patients is highly controversial. We aimed to systematically review the literature and perform a metaanalysis of available data relating to the effect of CAT on mortality of PCP in non-HIV patients. Methods: We searched Pubmed, Medline, Embase, and Cochrane database from 1989 through 2019. Data on clinical outcomes from non-HIV PCP were extracted with a standardized instrument. Heterogeneity was assessed with the I 2 index. Pooled odds ratios and 95% confidence interval were calculated using a fixed effects model. We analyzed the impact of CAT on mortality of non-HIV PCP in the whole PCP population, those who had hypoxemia (PaO 2 < 70 mmHg) and who had respiratory failure (PaO 2 < 60 mmHg). Results: In total, 259 articles were identified, and 2518 cases from 16 retrospective observational studies were included. In all non-HIV PCP cases included, there was an association between CAT and increased mortality (odds ratio, 1.37; 95% confidence interval 1.07-1.75; P = 0.01). CAT showed a probable benefit of decreasing mortality in hypoxemic non-HIV PCP patients (odds ratio, 0.69; 95% confidence interval 0.47-1.01; P = 0.05). Furthermore, in a subgroup analysis, CAT showed a significantly lower mortality in non-HIV PCP patients with respiratory failure compared to no CAT (odds ratio, 0.63; 95% confidence interval 0.41-0.95; P = 0.03). Conclusions: Our meta-analysis suggests that among non-HIV PCP patients with respiratory failure, CAT use may be associated with better clinical outcomes, and it may be associated with increased mortality in unselected non-HIV PCP population. Clinical trials are needed to compare CAT vs no-CAT in non-HIV PCP patients with respiratory failure. Furthermore, CAT use should be withheld in non-HIV PCP patients without hypoxemia.

Dear editor, We read with great interest in the report by Volta and colleagues [1] about the presence and determinant of expiratory flow limitation (EFL) developed in patients admitted to an intensive care unit (ICU). They found that the presence of EFL is common among ICU patients requiring mechanical ventilation for acute respiratory failure of different etiologies. And interestingly, the major determinant for developing EFL in patients during the first 3 days of their ICU stay is a positive fluid balance. However, whether there is a relationship among fluid overload, respiratory mechanics, and outcome is controversial, and we would like to add some comments. First, in Volta et al.'s work [1], 37 (31%) patients exhibited EFL upon admission, of whom 76%, 57%, and 43% had heart diseases, COPD or ARDS, and higher BMI, respectively. It is easily explainable that obese patients and those with COPD, heart disease, or ARDS can exhibit EFL at ICU admission [2]. Therefore, it should be more important to focus on patients who might develop EFL during the ICU stay and its mechanism. Second, whether fluid overload is the mechanism of developing EFL during the ICU stay was not fully explained by Volta et al.'s data [1]. A decreased respiratory system compliance and an increased airway resistance should be related to fluid overload-induced pulmonary edema, pleural effusion, or small airway swelling and closure [3]. Of note, in Volta's study,

No abstract

No abstract

No abstract