RT Journal Article
SR Electronic
T1 Responder status and long term outcomes of critically ill patients with ARDS receiving high dose steroids as rescue therapy in a specialist acute respiratory failure centre
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 2979
DO 10.1183/13993003.congress-2022.2979
VO 60
IS suppl 66
A1 T A Leahy
A1 A Chauhan
A1 V Nicholas
A1 P Patel
A1 J Alcada
A1 P Bianchi
A1 F Caetano
A1 S Desai
A1 J Doyle
A1 P Molyneux
A1 S Ledot
A1 S Padley
A1 A Devaraj
A1 C A Ridge
A1 B Rawal
A1 M Passariello
A1 S Price
A1 C Morgan
A1 M Kokosi
A1 B Patel
A1 A Wells
A1 G Ball
A1 T Xu
A1 A Bashir
A1 C Remmington
A1 S Singh
YR 2022
UL http://erj.ersjournals.com/content/60/suppl_66/2979.abstract
AB Background: High-dose steroids (HDS) are used in specialist settings for the treatment of ARDS with features suggesting steroid responsiveness or as a last resort. Our previous case-matched cohort demonstrated that HDS increase 6mo. mortality (Remmington et. al, 2019).Aims and objectives: Identify if response to HDS predicted favourable outcomes.Methods: A retrospective observational study from a tertiary specialist respiratory ICU identified 79 patients (5 excluded) between 2009-2017 who received HDS for ARDS (AECC/Berlin criteria). Patients were grouped according to the change in lung injury score (LIS) between days 0 and 10 following HDS initiation. A modified LIS (excluding PF ratios for patients on ECMO) was used. Changes in LIS were grouped as follows; full responders (FR) ≥ 2, partial responders (PR) ≥ 1 and < 2, and non-responders (NR) < 1.Results: This study identified 7 (9.5%) FR, 14 (18.9%) PR, and 53 (71.6%) NR. Figure 1 shows the mortality for each group, which was significantly reduced when comparing the combined PR+FR groups to the NR group (p (log rank test) < 0.0001).View this table:Figure 1 – mortality over time in patients with different LIS responsesConclusions: A low proportion (28.4%) of ARDS patients given HDS had a FR or PR by day 10 yet these patients had significantly reduced mortality at 24mo. Further research using modified LIS to predict steroid responsiveness may assist clinicians in selecting ARDS patients for rescue therapy.FootnotesCite this article as Eur Respir J 2022; 60: Suppl. 66, 2979.This article was presented at the 2022 ERS International Congress, in session “-”.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).