Aims & Objectives:
A recent meta-analysis in adult ARDS patients found improved mortality with methylprednisolone, but there remains a lack of level 1 evidence in paediatrics (1).This study aims to characterise response to steroid treatment in paediatric patients with severe pARDS treated in two PICUs.
A retrospective, observational study, included all patients prescribed IV methylprednisolone for the indication of pARDS between January 2011 and December 2016. All patients met the PALICC definition of pARDS, and were prescribed IV methylprednisolone (2mg/kg/day). Oxygenation index (OI) was evaluated daily, from admission until 7 days after methylprednisolone initiation.
84 patients met inclusion criteria. Median age was 9 months. 52 patients survived to ICU discharge (62%). A multi-linear regression analysis demonstrates improvement in mean OI in the 7 days following steroid administration (figure 1).
63 patients had an arterial catheter at the time of steroid commencement, and of these, 49 (77%) had a >20% improvement in OI following steroid administration. 80% of patients who demonstrated any improvement in OI did so in <72hrs. These patients were classified as ‘responders’ (n=38, 60%). Baseline characteristics were similar between ‘responders’ and ‘non-responders’. Univariable analysis showed a significant difference in VFD (p<0.05) between responders and non-responders. On a multivariable analysis including likely cofounders, response to steroids did not independently predict VFD.
Improvement in OI following administration of IV methylprednisolone for pARDs occurred within 3 days of commencement in most patients. These data can be used to inform the design of future trials of steroids in pARDS.
1. Meduri GU et al.Intensive Care Med. 2016 May;42(5):829–840.