Methylprednisolone Treatment Versus Standard Supportive Care for Adult COVID-19 Mechanically Ventilated, Acute Respiratory Distress Syndrome Patients

Abstract

A myriad of symptoms presented by severely ill mechanically ventilated COVID-19 patients has added pressure on the caregivers to explore therapeutic options. Systemic steroids have been reported to therapeutically benefit patients, with elevated inflammatory markers, during the severe acute respiratory syndrome, and the Middle East respiratory syndrome outbreak. COVID-19 disease is characterized by inflammation of the respiratory system and acute respiratory distress syndrome. Given the lack of specific treatment for COVID-19, the current study aimed to evaluate the therapeutic benefit of methylprednisolone as an add-on treatment for mechanically ventilated hospitalized COVID-19 patients with severe COVID pneumonia. Data were collected retrospectively from the electronic patient medical records, and interrater reliability was determined to limit selection bias. Descriptive and inferential statistical methods were used to analyze the data. The variables were cross-tabulated with the clinical outcome, and the chi-square test was used to determine the association between the outcomes and other independent variables. Sixty-one percent (43/70) of the COVID-19 ARDS patients received standard supportive care, and the remainder were administered, methylprednisolone (minimum 40 mg daily to a maximum 40 mg q 6 h). A 28-day all-cause mortality rate, in the methylprednisolone group, was 18% (5/27, p < 0.01) significantly lower, compared to the group receiving standard supportive care (51%, 22/43). The median number of days, for the hospital length of stay (18 days), ICU length of stay (9.5 days), and the number of days intubated (6 days) for the methylprednisolone-treated group, was significantly lower ( p < 0.01) when compared with the standard supportive care group. Methylprednisolone treatment also reduced the C-reactive protein levels, compared to the standard care group on day 7. Our results strengthen the evidence for the role of steroids in reducing mortality, ICU length of stay, and ventilator days in mechanically ventilated COVID-19 patients with respiratory distress syndrome.

Evolution of Acute Respiratory Distress Syndrome in Emergency and Critical Care: Therapeutic Management before and during the Pandemic Situation

“…Therefore, it would be advisable to clarify the conditions of its use. However, Zhang et al [48] stated that there is no association between the use of corticosteroids and ARDS mortality, and Rahman et al [49] even commented that methylprednisolone can reduce mortality, length of hospital stay, and duration of mechanical ventilation.…”

Effects of Tocilizumab on Adults With COVID-19 Pneumonia: A Meta-Analysis

“…At the end of 2020, treatment of COVID-19 was various. Classes of drugs used are antiviral agents (e.g., lopinavir/ritonavir and remdesivir), inflammation inhibitors/antirheumatic drugs (e.g., tocilizumab, antimalarials, and methylprednisolone), low molecular-weight heparin, plasma, and hyperimmune immunoglobulins ( 3 , 9 ). Definite therapy was still under development and research.…”

“…Since there are no definite antiviral drugs existing to fully treat or prevent COVID-19, potential therapeutic strategies arecurrently being evaluated in full swing ( 2 ). For example, systemic steroids have been reported to benefit severely ill mechanically ventilated patients with COVID-19 ( 3 ). Severe dysregulated systemic inflammation is the putative mechanism.…”

“…Because of highly infectious COVID-19 pneumonia, finding out a definite therapy was the top priority. Critically ill patients with COVID-19 might add heavy pressure on the medical system ( 3 ). The use of the IL-6 inhibitor in treating COVID-19 is still controversial.…”