A short course of prednisolone in patients with moderate Covid 19 respiratory failure- stop the progression a case series.

Abstract

\n Introduction This case series outlines the results of using prednisolone in patients with moderated respiratory failure secondary to Covid 19 pneumonitis to prevent the progression to invasive ventilation. There is no consensus on the use of prednisolone in Moderate Covid respiratory failure early in the pandemic this should be an additional option where Dexamethasone is not available. Consent was obtained by the patients for anonymous publication of their data.Clinical Findings The author provides evidence of four (4) Covid 19 positive cases admitted to the High dependency Unit with moderate respiratory failure, defined as needing supplementary oxygen therapy to maintain saturations above 90%, who when treated with prednisolone rapidly decreased their oxygen requirement and were successfully weaned to room air within 72 hours of initiation of steroids.Diagnosis Four (4) patients admitted to the High Dependency Unit diagnosed with moderate respiratory failure secondary to PCR positive Covid 19.Intervention Covid 19 positive patients requiring oxygen therapy to maintain saturations above 90% were given a trial of oral prednisolone between 15-30mg until they were weaned to room air maintaining saturations >95%.Outcome Rapid resolution of worsening respiratory function of Covid 19 positive patients within the High Dependency unit in a tertiary medical center. The signs and symptoms of respiratory failure resolved after 72 hours of prednisolone treatment and none of these patients were escalated to non-invasive or invasive respiratory support. The patients were kept for a further 48 hours after the steroids were discontinued to monitor for relapse of symptoms which none of them had.Conclusion Initiation of a prednisolone steroid trial must be considered in Covid 19 positive patients needing supplementary oxygen therapy or developing worsening shortness of breath. Early Covid respiratory failure responds to a low dose for a short duration and prevents escalation to non-invasive/invasive respiratory support.