For a study, researchers sought to ascertain whether ventilator-associated pneumonia (VAP) was caused by early corticosteroid treatment for COVID-19 acute respiratory distress syndrome (ARDS). Patients with COVID-19-ARDS who required invasive mechanical ventilation (MV) for more than 48 hours at any 1 of 15 intensive care units were enrolled in the study in 2020. Depending on whether or not they had received corticosteroids in the previous 24 hours, investigators divided the patients into 2 groups. Given that extubation and mortality were competing endpoints, the key finding was VAP incidence. Day 90 mortality, MV length, various organ dysfunctions, and VAP features were secondary outcomes. About 369 of the 670 patients (mean age: 65), as opposed to the 301 individuals, received early corticosteroids. (adjusted hazard ratio [aHR] 1.29; 95% CI [(95% CI) 1.05-1.58; P=0.016] Early use of corticosteroids was associated with a higher cumulative incidence of VAP. There was no difference between the 2 groups in the antibiotic resistance of the VAP bacteria (odds ratio 0.94, 95% CI 0.58-1.53; P=0.81). After adjusting for age, SOFA score, and the presence of VAP, the 90-day death rate was 30.9% with early corticosteroids and 24.3% without them (aHR 1.15; 95% CI 0.83-1.60; P=0.411). A greater 90-day death rate was linked to VAP (aHR 1.86; 95% CI 1.33-2.61; P=0.0003). Early corticosteroid therapy was linked to VAP in COVID-19-ARDS patients. Early corticosteroid medication was not related to a greater 90-day death rate, although VAP was. Therefore, longitudinal randomized controlled studies should assess early corticosteroids in COVID-19-ARDS requiring MV.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-022-04097-8
