Systemic corticosteroids (SCS) have been shown to be beneficial in Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD). The beneficial effect of SCS in mechanically ventilated patients with AECOPD has not been thoroughly investigated. Objective: The goal of this study was to determine whether SCS have an effect on the duration of mechanical ventilation (MV) in patients with AECOPD.
We reviewed the records of 112 mechanically ventilated patients with AECOPD admitted to our Intensive Care Unit over five years. Patients with congestive heart failure, sepsis, cardiac arrest, stroke, terminal malignancies or “Do Not Resuscitate” orders were excluded. Patients receiving SCS one month prior to admission were also excluded. 20 patients met the selected inclusion and exclusion criteria. 10 patients received SCS during the duration of MV. Both groups were matched for age, weight, sex, weight, body mass index, vasopressor and oxygen requirements in the first 24 hours and co-morbidities. All patients followed the standard ICU MV and weaning protocols. Primary end point was duration of MV and secondary end point was duration of ICU stay.
The results of our study are summarized in the following tableMeanSDP-valuesDuration of MV (days)t-testMann-WhitneyNo Steroids(n=10)6.83.46Steroids(n=10)14.028.680.4410.353ICU Stay (days)No Steroids(n=10)12.06.43Steroids(n=10)16.328.060.6420.165. The considerable differences in mean values between steroid and non-steroid groups were the result of a single steroid-group subject with an extremely long stay (MV and ICU both 95 days). When this outlier was eliminated, the remaining 9 steroid subjects had a mean of 5.0 MV days (SD=3.74) and a mean ICU stay of 7.56 days (SD=5.08), both values being less than comparable non-steroid group means.
SCS do not seem to benefit mechanically ventilated patients with AECOPD. Larger well designed prospective studies are needed to confirm the findings of this study.
More research is needed to define a role for SCS in mechanicaly ventilated patients with AECOPD.
A.M. Rashid, None.