PURPOSE: Systemic corticosteroids are the mainstay of therapy for COPD exacerbation along with oxygen therapy, bronchodilators and antibiotics. They are shown to reduce treatment failure rates, hospital length of stay (LOS) as well as to improve lung function tests and dyspnea scores. The optimal dose and duration of steroid therapy is not defined specially in patients requiring mechanical ventilator (MV) support in the intensive care unit (ICU) setting. The purpose of our study was to compare outcomes with low dose (≤ 80mg methylprednisolone) vs high dose (> 80mg methylprednisolone) intravenous corticosteroid therapy in critically ill patients with severe COPD exacerbation requiring MV support.
METHODS: We retrospectively reviewed charts of patients admitted from January 2006 to January 2010 to MICU with initial diagnosis of respiratory failure secondary to COPD exacerbation requiring MV support at the time of admission. Demographics of patients, severity of illness scores, and comorbidity parameters were recorded. Outcomes measures were ventilator days, tracheostomy rates, hospital / ICU LOS, survival and discharge location.
RESULTS: 130 patients were reviewed in study with 49 receiving low dose (≤ 80mg) and 81 receiving high dose (>80mmhg) intravenous methylprednisolone on 1st 24 hrs ICU stay with gradual taper to po prednisone as condition improves. Mean age was 74.5 ± 11.3 in low dose group and 71.9 ± 10.9 in high dose group and mean APACHE II score of 17.3 ± 5.5 and 16.5 ± 3.9 respectively. Almost all patients received bronchodilators and antibiotics treatment. All outcome parameters including ventilator days, tracheostomy rates, LOS, survival and discharge location showed favorable trend in high dose group in comparison to low dose, but only ventilator days 4.1±3.2 vs 7.3±9.7( P = 0.007, CI = 0.888 - 5.512), tracheostomy rate 9% vs 26% ( P = 0.0249), and ICU length of stay 7.0±5.0 vs 10.5±10( P = 0.009, CI = 8.89 - 6.11) were statistically significant.
CONCLUSIONS: High dose corticosteroid therapy for severe COPD exacerbation resulted in a lower ventilator days, decreased need for tracheostomy, and a decreased ICU LOS.
CLINICAL IMPLICATIONS: Severe COPD exacerbation requiring MV support should be treated with high dose corticosteroids.
DISCLOSURE: The following authors have nothing to disclose: Tejal Shah, Mahendi Haran, Yizhak Kupfer, Chanaka Seneviratne, Sidney Tessler
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