Relationship of Steroid Dosing and Duration of Mechanical Ventilation in Adult Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Abstract

Background: The optimal steroid dose for patients who require mechanical ventilation (MV) for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is unknown. Objective: The primary objective of the study is to describe the relationship between steroid doses prescribed and duration of MV. Methods: This was a retrospective study of patients admitted between October 2013 and September 2014 who were prescribed steroids and received MV for ≥48 hours for AECOPD. Results: Fifty-four patients were included in the study. Median maintenance daily dose of 300 mg/d (IQR: 150-300) prednisone equivalent was prescribed upon initiation of MV. The maintenance daily dose prescribed upon initiation of MV was visually plotted and was categorized into 2 groups: high dose (≥300 mg; n = 28) and low dose (<300 mg; n = 26). There was no relationship observed between the maintenance dose prescribed and duration of MV (P = .44) or intensive care unit (ICU) length of stay (LOS; P = .63). Seventeen (31.5%) patients developed an infection during their hospital stay. These patients received a higher cumulative dose of steroids compared to those without an infection (P = .035). Conclusion: No relationship was observed between maintenance steroid dose prescribed and the duration of MV or ICU LOS. Evaluation of a safe and effective dose and duration of steroids in this population is warranted.