TY  - JOUR
A1  - Zeiner, Carsten
A1  - Schröder, Malte
A1  - Metzner, Selina
A1  - Herrmann, Johannes
A1  - Notz, Quirin
A1  - Hottenrott, Sebastian
A1  - Röder, Daniel
A1  - Meybohm, Patrick
A1  - Lepper, Philipp M.
A1  - Lotz, Christopher
T1  - High-dose methylprednisolone pulse therapy during refractory COVID-19 acute respiratory distress syndrome: a retrospective observational study
T2  - BMC Pulmonary Medicine
N2  - Background
Current COVID-19 guidelines recommend the early use of systemic corticoids for COVID-19 acute respiratory distress syndrome (ARDS). It remains unknown if high-dose methylprednisolone pulse therapy (MPT) ameliorates refractory COVID-19 ARDS after many days of mechanical ventilation or rapid deterioration with or without extracorporeal membrane oxygenation (ECMO).

Methods
This is a retrospective observational study. Consecutive patients with COVID-19 ARDS treated with a parenteral high-dose methylprednisolone pulse therapy at the intensive care units (ICU) of two University Hospitals between January 1st 2021 and November 30st 2022 were included. Clinical data collection was at ICU admission, start of MPT, 3-, 10- and 14-days post MPT.

Results
Thirty-seven patients (mean age 55 ± 12 years) were included in the study. MPT started at a mean of 17 ± 12 days after mechanical ventilation. Nineteen patients (54%) received ECMO support when commencing MPT. Mean paO2/FiO2 significantly improved 3- (p = 0.034) and 10 days (p = 0.0313) post MPT. The same applied to the necessary FiO2 10 days after MPT (p = 0.0240). There were no serious infectious complications. Twenty-four patients (65%) survived to ICU discharge, including 13 out of 20 (65%) needing ECMO support.

Conclusions
Late administration of high-dose MPT in a critical subset of refractory COVID-19 ARDS patients improved respiratory function and was associated with a higher-than-expected survival of 65%. These data suggest that high-dose MPT may be a viable salvage therapy in refractory COVID-19 ARDS.
KW  - corticoid
KW  - methylprednisolone
KW  - pulse therapy
KW  - SARS-CoV2
KW  - ECMO
KW  - salvage therapy
Y1  - 2023
UR  - https://opus.bibliothek.uni-wuerzburg.de/frontdoor/index/index/docId/35723
UR  - https://nbn-resolving.org/urn:nbn:de:bvb:20-opus-357231
VL  - 23
ER  -