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. 2022 Aug 2;26(1):233.
doi: 10.1186/s13054-022-04097-8.

Early steroids and ventilator-associated pneumonia in COVID-19-related ARDS

Pauline Lamouche-Wilquin  1 , Jérôme Souchard  2   3 , Morgane Pere  4 , Matthieu Raymond  1 , Pierre Asfar  5 , Cédric Darreau  6 , Florian Reizine  7 , Baptiste Hourmant  8 , Gwenhaël Colin  9 , Guillaume Rieul  2 , Pierre Kergoat  10 , Aurélien Frérou  11 , Julien Lorber  12 , Johann Auchabie  13 , Béatrice La Combe  14 , Philippe Seguin  3 , Pierre-Yves Egreteau  15 , Jean Morin  16 , Yannick Fedun  2 , Emmanuel Canet  1 , Jean-Baptiste Lascarrou  17 , Agathe Delbove  2
Affiliations

Early steroids and ventilator-associated pneumonia in COVID-19-related ARDS

Pauline Lamouche-Wilquin et al. Crit Care. .

Abstract

Rationale: Early corticosteroid treatment is used to treat COVID-19-related acute respiratory distress syndrome (ARDS). Infection is a well-documented adverse effect of corticosteroid therapy.

Objectives: To determine whether early corticosteroid therapy to treat COVID-19 ARDS was associated with ventilator-associated pneumonia (VAP).

Methods: We retrospectively included adults with COVID-19-ARDS requiring invasive mechanical ventilation (MV) for ≥ 48 h at any of 15 intensive care units in 2020. We divided the patients into two groups based on whether they did or did not receive corticosteroids within 24 h. The primary outcome was VAP incidence, with death and extubation as competing events. Secondary outcomes were day 90-mortality, MV duration, other organ dysfunctions, and VAP characteristics.

Measurements and main results: Of 670 patients (mean age, 65 years), 369 did and 301 did not receive early corticosteroids. The cumulative VAP incidence was higher with early corticosteroids (adjusted hazard ratio [aHR] 1.29; 95% confidence interval [95% CI] 1.05-1.58; P = 0.016). Antibiotic resistance of VAP bacteria was not different between the two groups (odds ratio 0.94, 95% CI 0.58-1.53; P = 0.81). 90-day mortality was 30.9% with and 24.3% without early corticosteroids, a nonsignificant difference after adjustment on age, SOFA score, and VAP occurrence (aHR 1.15; 95% CI 0.83-1.60; P = 0.411). VAP was associated with higher 90-day mortality (aHR 1.86; 95% CI 1.33-2.61; P = 0.0003).

Conclusions: Early corticosteroid treatment was associated with VAP in patients with COVID-19-ARDS. Although VAP was associated with higher 90-day mortality, early corticosteroid treatment was not. Longitudinal randomized controlled trials of early corticosteroids in COVID-19-ARDS requiring MV are warranted.

Keywords: Dexamethasone; Mechanical ventilation; Methylprednisolone; Nosocomial pneumonia; SARS-CoV-19.

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Conflict of interest statement

All authors have completed and submitted the ICMJE Form for disclosure of potential conflicts of interest. All authors have any conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Patient flowchart
Fig. 2
Fig. 2
VAP probability according to time
Fig. 3
Fig. 3
Cumulative incidence of death according to the occurrence of VAP with extubation as a competing event
See this image and copyright information in PMC

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