Systemic corticosteroids in the management of covid-19 ARDS


Authors: F. Keller;  V. Kočí;  K. Řiháková;  J. Maláska;  J. Stašek
Authors‘ workplace: Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Brno, Lékařská fakulta Masarykovy univerzity
Published in: Anest. intenziv. Med., 32, 2021, č. 3, s. 150-155
Category: Review Article

Overview

Human coronavirus SARS-CoV-2 (Severe acute respiratory coronavirus 2), due to its ability to cause lung injury in significant percentage of patients, represents great medical and even social problem. Since the outbreak of the pandemic at the end of 2019, many new therapeutics have been tested. Unfortunatelly, real benefit in high quality studies was confirmed in just a few of them. One of these exceptions is represented by corticosteroids used in patients with advanced grade of oxygenation failure. Corticosteroids have favorable influence on lung injury and potentially facilitate reparation of pulmonary functions by modulating inflammatory response mediated through glucocorticoid receptors. Their benefit was confirmed in several randomized trials and they actually represent an integral part of complex care in those patients with pneumonia caused by SARS-CoV-2, who are in need of oxygenotherapy or mechanical ventilation. Nevertheless, uncertainty exists regarding their optimal dose in such a broad spectrum of patients. Data from former studies performed in non coronavirus patients with Acute Respiratory Distress Syndrome (ARDS) favor rather larger doses of steroids than those tested in covid-19 patients. Also optimal timing and choice of specific corticosteroid remains unknown. Ongoing clinical trials could provide answers to these relevant questions.

Keywords:

COVID-19 – ARDS – corticosteroids


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