在耐火性COVID-19急性呼吸窘迫综合征期间高剂量甲基普雷迪尼索隆脉冲治疗:一项回顾性观察性研究
Carsten Zeiner1, Malte Schröder2, Selina Metzner1
1Department of Internal Medicine V, Saarland University Hospital, Kirrbergerstr. 100, 66421, Homburg/Saar, Germany.
BMC pulmonary medicine
|October 3, 2023
概括
高剂量的甲基普雷迪尼索隆脉冲疗法 (MPT) 改善了重症COVID-19急性呼吸窘迫综合征 (ARDS) 患者的呼吸功能. 这种晚期的MPT显示了65%的生存率,这表明它是潜在的救援疗法.
科学领域:
- 关键护理医学 关键护理医学
- 肺部病理学 肺部病理学
- 传染性疾病 传染性疾病
背景情况:
- 目前的COVID-19指南倡导早期系统性皮质类固醇治疗COVID-19急性呼吸系统应急综合征 (ARDS).
- 高剂量甲基普雷迪尼索隆脉冲疗法 (MPT) 在耐火性COVID-19ARDS中,特别是经过长时间的机械通风或快速恶化 (带有或没有体外膜氧化[ECMO]) 后,高剂量甲基普雷迪尼索隆脉冲疗法的疗效仍然不清楚.
研究的目的:
- 为了评估晚期给出的高剂量甲基prednisolone脉冲疗法 (MPT) 在耐火性COVID-19 ARDS患者的有效性.
- 评估MPT对COVID-19 ARDS患者的一个关键子组的呼吸功能和生存的影响.
主要方法:
- 追溯观察性研究,包括连续患有COVID-19 ARDS的患者,接受亲肠道高剂量MPT治疗.
- 在重症监护室 (ICU) 入院,MPT启动以及MPT后3,10和14天收集的数据.
- 在2021年1月至2022年11月期间,患者在两个大学医院接受了MPT.
主要成果:
- 包括37名患者 (平均年龄55岁);机械呼吸术开始后的MPT平均为17天.
- 在MPT启动时,有19名患者 (54%) 需要ECMO支持.
- 在MPT后3天和10天观察到PaO2/FiO2比率的显著改善 (分别为p=0.034,p=0.0313). 在10天 (p=0.0240) 时发现减少了FiO2的需求. 报告没有严重的传染性并发症. 整体ICU存活率为65% (24/37名患者),包括65% (13/20) 的ECMO支持患者.
结论:
- 晚期高剂量MPT在不耐药的COVID-19 ARDS患者中改善了呼吸功能.
- 这一关键队列中65%的存活率表明,MPT可能成为耐受性COVID-19 ARDS的可行救援疗法.
- 进一步调查MPT在COVID-19 ARDS晚期的作用是有必要的.
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