1161: TIMELINESS OF CORTICOSTEROID USE IN ICU PATIENTS WITH PNEUMONIA AND ARDS

Abstract

Learning Objectives: The use of steroids in Acute Respiratory Distress Syndrome (ARDS) and pneumonia is controversial and clinical practice is heterogeneous. Our objective was to evaluate the effect of timely steroid administration on patient outcomes in patients with pneumonia and/or ARDS. Methods: This was an observational single-center retrospective study of adult patients with acute respiratory failure secondary to pneumonia and/or ARDS admitted to the intensive care unit at Mayo Clinic Rochester, MN from January 1, 2009 to June 30, 2014. Results: Of 3607 patients with pneumonia or ARDS, 1614 (45%) received steroids during their ICU stay. We compared patients who received steroids within 12 hours of ICU admission (65%) with those who received steroids greater than 12 hours after admission (35%). There were no significant differences in sex (males: 55.2% vs 51.9%, p=0.2), age (70 (57–79) vs 68 (57–78), p=0.3), Charlson Comorbidity Index (7 (4–10) vs 7 (4–10), p=0.2), PaO2/FiO2 ratio (173 (117–250) vs 161 (108–240), p=0.2), and SpO2/FiO2 ratio (167 (118–235) vs 170 (100–233), p=0.9). Those who received early steroids had a higher P/F ratio than those who received delayed steroids at 24 hours (196 (143–265) vs 183 (122–255), p=0.03), and 48 hours (209 (145–284) vs 191 (129–255), p=0.03). Those receiving early steroids also had reduced need (69.4 vs 76.4%, p=0.003) and duration (1.48 (0.45–4.04) vs 3.03 (1.16–6.85) days, p<0.001) of mechanical ventilation. After adjusting for age, sex, admission SOFA, admission APACHE III, Charslon Comorbidity Index, asthma and COPD, there was a lower hospital mortality (OR 0.76, 95%CI 0.59–0.99, p=0.04) and shorter hospital length of stay by 2.36 days (SE 0.54, p<0.001) in the early steroid group. Conclusions: In those patients who received corticosteroids in the ICU for pneumonia or ARDS, early steroid administration (defined as within 12 hours of ICU admission) was associated with improved patient outcomes. These findings support the need for prospective studies studying corticosteroid administration in acute respiratory failure.