S01E09 Adjunctive Glucocorticoids in CAP: The SONIA Pragmatic RCT

Welcome to PRISM Rounds, where we break down one study at a time.This week we review the SONIA trial (a pragmatic randomized clinical trial across Kenyan public hospitals) evaluating whether adjunctive low-dose glucocorticoids added to usual care reduce 30-day mortality in adults hospitalized with community-acquired pneumonia (CAP)—and we pair it with the accompanying NEJM editorial on why context and implementation matter.We discuss: trial design choices in low-resource settings, interpreting absolute vs relative effects, safety/feasibility (especially glucose monitoring), and what ICU/ward teams (physicians, trainees, nurses, pharmacists, and respiratory therapists) can reasonably take back to practice.Educational purpose only. This episode is for education and discussion and is not medical advice.Links:NEJM Trial (SONIA): https://www.nejm.org/doi/abs/10.1056/NEJMoa2507100NEJM Editorial: https://www.nejm.org/doi/abs/10.1056/NEJMe2514533PubMed (Editorial): https://pubmed.ncbi.nlm.nih.gov/41159881/TagsPRISM Rounds, Pulmonary, Critical Care, Hospital Medicine, Infectious Diseases, Community-Acquired Pneumonia, CAP, Sepsis, Global Health, Low-Resource Settings, Pragmatic Trial, Randomized Trial, NEJM, Glucocorticoids, Steroids, Mortality, Evidence-Based Medicine, Journal Club, Clinical Epidemiology, Medical Education