Assuntos
Broncodilatadores/administração & dosagem , COVID-19/terapia , Óxido Nítrico/administração & dosagem , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório/terapia , Administração por Inalação , COVID-19/epidemiologia , Feminino , Humanos , Masculino , Síndrome do Desconforto Respiratório/epidemiologia , Estudos RetrospectivosRESUMO
Patients with COVID-19 ARDS have distinct physiological and immunological phenotypes compared to patients with non-COVID ARDS. Patients with COVID-19 ARDS (n = 32) had a significant improvement in PaO2: FiO2 ratio (p = 0.046) following low-dose steroid treatment, unlike patients with non-COVID ARDS (n = 16) (p = 0.529). Patients with COVID-19 ARDS had a greater fall in CRP compared to patients with non-COVID ARDS, albeit not statistically significant (p = 0.07). Our novel findings highlight differences in the underlying physiological and immunological phenotypes between COVID-19 and non-COVID ARDS, with implications for future ARDS studies.
Assuntos
Anti-Inflamatórios/uso terapêutico , Tratamento Farmacológico da COVID-19 , COVID-19/fisiopatologia , Síndrome do Desconforto Respiratório/tratamento farmacológico , Síndrome do Desconforto Respiratório/fisiopatologia , Esteroides/uso terapêutico , Adulto , Idoso , Proteína C-Reativa/efeitos dos fármacos , Feminino , Humanos , Hidrocortisona/uso terapêutico , Londres/epidemiologia , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Fenótipo , Mecânica Respiratória , Estudos Retrospectivos , SARS-CoV-2RESUMO
OBJECTIVES: Recent studies have demonstrated mortality benefits from corticosteroid use in COVID-19 patients requiring respiratory support. However, clinical practice may warrant the use of corticosteroids outside the context of a clinical trial. Such data are rarely, if ever, reported. We explored the use of corticosteroids for adult respiratory distress syndrome (ARDS) indications in patients with non-COVID ARDS. METHODS: We retrospectively studied patients with moderate-to-severe ARDS, admitted to our intensive care unit (ICU) between January 2018 and March 2020. KEY FINDINGS: Of the 91 patients with ARDS identified, 80% were treated with a corticosteroid during their ICU admission. Of these, 73 (82%) had corticosteroids administered for reasons other than ARDS. CONCLUSIONS: Corticosteroid use for non-ARDS indications is commonplace in ARDS patients in our ICU. The use of corticosteroids outside a randomisation process in randomised clinical trials may be more common than appreciated and needs to be routinely reported.