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Methylprednisolone dosing for pediatric critical asthma: a single-center cohort study
Corey A Fowler1, Jennifer M Ryder2, Alexa R Roberts3
1Department of Pharmacy, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.
Insights
Conservative-dose methylprednisolone (MP) in children with critical asthma (CA) led to shorter treatment durations and hospital stays. This study characterized MP dosing and outcomes, finding no adverse events with lower doses.
Area of Science:
- Pediatric critical care medicine
- Pharmacology and therapeutics
- Respiratory medicine
Background:
- Critical asthma (CA) in children requires intensive management, often involving intravenous methylprednisolone (MP).
- Dosing strategies for MP in pediatric CA vary, necessitating an understanding of their impact on clinical outcomes.
Purpose of the Study:
- To characterize intravenous methylprednisolone (MP) dosing regimens in children hospitalized for critical asthma (CA).
- To evaluate the association between different MP dosing strategies and clinical outcomes, including treatment duration and length of stay (LOS).
Main Methods:
- A retrospective review of 168 children (5-17 years) admitted to the pediatric intensive care unit (PICU) for CA was conducted.
- Patients received continuous nebulized albuterol and at least one dose of IV MP.
- Cohorts were defined by MP dose: conservative (CDMP, ≤ 0.5 mg/kg/dose q6h) versus standard (SDMP, > 0.5 mg/kg/dose q6h).
Main Results:
- Of 168 children, 50 (29.8%) received CDMP and 118 (70.2%) received SDMP.
- Children on CDMP had significantly shorter durations of continuous nebulized albuterol (12.8 vs. 17.3 hours, p=0.019) and PICU LOS (0.9 vs. 1.2 days, p=0.012).
- No corticosteroid-related adverse events were observed; however, adjusted models showed no association between weight-adjusted IV MP dose and PICU LOS or albuterol duration.
Conclusions:
- Intravenous MP dosing for pediatric CA demonstrated wide variability in the study sample.
- Conservative dosing of IV MP was associated with shorter treatment and hospital durations.
- Prospective, controlled trials are needed to validate these findings on clinical efficacy and safety.
Objective:
We aimed to characterize intravenous (IV) methylprednisolone (MP) dosing regimens and clinical outcomes for children hospitalized for critical asthma (CA).
Methods:
A single-center, retrospective review was performed of children admitted to the pediatric intensive care unit (PICU) for CA between September 2015 and October 2019. Patients 5-to 17-year-olds, initiated on continuous nebulized albuterol, and prescribed at least one dose of IV MP were included. The primary outcome was to characterize PICU MP dosing. Cohorts were then compared by MP dosing: conservative-dose methylprednisolone (CDMP, ≤ 0.5 mg/kg/dose every 6 h) and standard-dose methylprednisolone (SDMP, > 0.5 mg/kg/dose every 6 h). Clinical efficacy endpoints were the duration of continuous nebulized albuterol and PICU length of stay (LOS). Safety endpoints included corticosteroid-related adverse events.
Results:
Of 168 children studied, 50 (29.8%) were prescribed CDMP and 118 (70.2%) SDMP. The overall mean MP dose was 31.3 ± 19.6 mg (weight-adjusted: 0.77 ± 0.32 mg/kg/dose). Compared to those prescribed SDMP, those prescribed CDMP had a shorter median duration of continuous nebulized albuterol (12.8 [IQR: 10.5-20] versus 17.3 [IQR: 11.3-29.7] hours, p = 0.019) and median PICU LOS (0.9 [IQR: 0.7-1.4] versus 1.2 [IQR: 0.9-1.8] days, p = 0.012). No corticosteroid-related adverse events were observed. In adjusted models, weight-adjusted IV MP dose was not associated with PICU LOS or duration of continuous nebulized albuterol.
Conclusions:
Intravenous MP dosing for pediatric CA varied widely in our study sample. Prospective, controlled trials are required to validate our observations including clinical efficacy and safety endpoints.
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