Improved oxygenation following methylprednisolone therapy and survival in paediatric acute respiratory distress syndrome


Autoři: Rebecca B. Mitting aff001;  Samiran Ray aff002;  Michael Raffles aff001;  Helen Egan aff001;  Paul Goley aff001;  Mark Peters aff002;  Simon Nadel aff001
Působiště autorů: Paediatric Intensive Care Unit, Imperial College Healthcare NHS Trust, London, United Kingdom aff001;  Paediatric and Neonatal Intensive Care Unit, Great Ormond Street Hospital NHS Trust, London, United Kingdom aff002;  Respiratory, critical care and anaesthesia section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom aff003
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225737

Souhrn

Background

Methylprednisolone remains a commonly used ancillary therapy for paediatric acute respiratory distress syndrome (PARDS), despite a lack of level 1 evidence to justify its use. When planning prospective trials it is useful to define response to therapy and to identify if there is differential response in certain patients, i.e. existence of ‘responders’ and ‘non responders’ to therapy. This retrospective, observational study carried out in 2 tertiary referral paediatric intensive care units aims to characterize the change in Oxygen Saturation Index, following the administration of low dose methylprednisolone in a cohort of patients with PARDS, to identify what proportion of children treated demonstrated response, whether any particular characteristics predict response to therapy, and to determine if a positive response to corticosteroids is associated with reduced Paediatric Intensive Care Unit mortality.

Methods

All patients who received prolonged, low dose, IV methylprednisolone for the specific indication of PARDS over a 5-year period (2011–2016) who met the PALICC criteria for PARDS at the time of commencement of steroid were included (n = 78).OSI was calculated four times per day from admission until discharge from PICU (or death). Patients with ≥20% improvement in their mean daily OSI within 72 hours of commencement of methylprednisolone were classified as ‘responders’. Primary outcome measure was survival to PICU discharge.

Results

Mean OSI of the cohort increased until the day of steroid commencement then improved thereafter. 59% of patients demonstrated a response to steroids. Baseline characteristics were similar between responders and non-responders. Survival to PICU discharge was significantly higher in ‘responders’ (74% vs 41% OR 4.14(1.57–10.87) p = 0.004). On multivariable analysis using likely confounders, response to steroid was an independent predictor of survival to PICU discharge (p = 0.002). Non-responders died earlier after steroid administration than responders (p = 0.003).

Conclusions

An improvement in OSI was observed in 60% of patients following initiation of low dose methylprednisolone therapy in this cohort of patients with PARDS. Baseline characteristics fail to demonstrate a difference between responders and non-responders. A 20% improvement in OSI after commencement of methylprednisolone was independently predictive of survival, Prospective trials are needed to establish if there is a benefit from this therapy.

Klíčová slova:

Acute respiratory distress syndrome – Immune response – Intensive care units – Pediatrics – Steroid therapy – Steroids – Corticosteroid therapy – Neuromuscular blockade


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Článek vyšel v časopise

PLOS One


2019 Číslo 11