Corticosteroid exposure in pediatric acute respiratory distress syndrome

Purpose Use of systemic corticosteroids in acute respiratory distress syndrome (ARDS) remains controversial, and studies in children are lacking. Methods We performed an observational, single-center study in a prospectively enrolled cohort of children meeting criteria for ARDS (both Berlin 2012 and AECC 1994 acute lung injury) and pediatric ARDS (PARDS, as defined by PALICC 2015). Comprehensive analysis of corticosteroid utilization was planned, and detailed information collected on corticosteroid use, timing, treatment duration, and cumulative dose while mechanically ventilated. We assessed the association between corticosteroid exposure >24 h and outcomes. Results Of the 283 children with PARDS (37 deaths, 13 %), 169 (60 %) received corticosteroids for >24 h while ventilated: 51 % hydrocortisone, 41 % methylprednisolone, 5 % dexamethasone, 3 % combination of corticosteroids. Corticosteroid exposure >24 h was associated with increased mortality, fewer ventilator-free days at 28 days (VFD), and longer duration of ventilation in survivors in unadjusted analyses (all p 24 h in patients with [greater than or equal to]3 organ failures and immunocompromised patients. Conclusions Corticosteroid exposure >24 h was independently associated with fewer VFD and longer duration of ventilation in survivors, even after adjustment for key potential confounders, including severity of illness, oxygenation index, immunocompromised status, and number of organ failures.
Author(s): Nadir Yehya [sup.1], Sabah Servaes [sup.2], Neal J. Thomas [sup.3], Vinay M. Nadkarni [sup.1], Vijay Srinivasan [sup.1] Author Affiliations: (1) grid.239552.a, 0000000106808770, Department of Anesthesiology and Critical Care Medicine, [...]