Use Of Methylprednisolone In Patients Research Articles

The Effect of Methylprednisolone on the Clinical and Laboratory Manifestations of a New Coronavirus Disease - 2019 Complicated by Severe Pneumonia

The article presents current data on the use of methylprednisolone in patients with COVID-19 (COronaVIrus Disease 2019) and severe pneumonia. The author presents his own observation of patients with COVID-19 complicated by severe pneumonia, where different modes of “pulse therapy” with methylprednisolone were used. It was shown that therapy with high doses of methylprednisolone had a positive effect on the course of COVID-19 complicated by severe pneumonia. On the background of therapy with methylprednisolone in the form of a pulse, the levels of interleukin-6, C-reactive protein in the blood and the erythrocyte sedimentation rate significantly decreased. During treatment with methylprednisolone, the blood pressure level remained stable, the thermometry and the degree of blood oxygen saturation normalized. During the observation of patients with COVID-19 complicated by severe pneumonia who received methylprednisolone in the form of “pulse therapy”, no undesirable effects were noted. Hyperglycemia was transient and did not require hypoglycemic therapy.

Prehospital Cervical Spine (C-spine) Stabilization and Airway Management in a Trauma Patient: A Review.

Severe traumatic damage to the brain-to-body signaling bundle that results in bruising and a partial or total tear of the spinal cord is known as a spinal cord injury (SCI). SCI may develop at the time of an eventor after. It can also developwhile handling the patient andcan worsen during the transportation of the patient. So prehospital care is crucial to prevent or minimize SCI. Prehospital care involves examining the patient, immobilizing the cervical spine (C-spine), providing cardiovascular support (keeping the mean arterial blood pressure over 85 mmHg), and carefully managing the airway (possibly intubating the patient using manual in-line stabilization (MILS)).Methylprednisolone (MPS) and other pharmacological treatments have not been shown to offer clinically meaningful and essential benefits for people with SCI. The therapeutic use of MPS in patients with SCI in the prehospital context is no longer supported. Additionally, whether or not pharmaceutical drugs will be effective in therapeutic hypothermiais unknown. When performing endotracheal intubation on these patients, the potential for C-spine damage is always considered. During intubation, the MILSapproach significantly reduces C-spine movement. The MILS method, however, can potentially restrict mouth opening and result in subpar laryngoscopic vision. These issues can be handled using the recently developed video laryngoscope, such as Airtraq laryngoscope and AirWay Scope (AWS). Compared to a direct laryngoscope, the AWSand Airtraqlaryngoscope reduced the improvement of intubation conditions and the acceleration of tracheal intubation through the occiput-C1 and C2-C4 levels of the C-spineextension movement.

Glucocorticoids in Myositis: Initiation, Tapering, and Discontinuation.

We discuss the evidence behind the use of glucocorticoids in myositis including a discussion of mechanism of action, dosing, tapering, and duration of therapy as well as glucocorticoid-related adverse events that are particularly important in myositis patients. Studies showing reduction in mortality rates after the use of glucocorticoids, better outcomes in patients treated with glucocorticoids compared to those who did not, and reduction of inflammation in muscle biopsies provide low level evidence to support use of glucocorticoids in myositis. Early initiation of therapy is associated with better functional outcomes. Use of intravenous methylprednisolone in patients with severe disease may lead to quicker recovery and reduction in long-term glucocorticoid exposure. Steroid-related myopathy and osteoporosis are glucocorticoid side effects that are particularly relevant in myositis. The optimal dose and duration of glucocorticoid therapy in myositis currently remain elusive, and this review emphasizes the need for better quality studies in this area.

The use of methylprednisolone in patients with Coronavirus disease 2019 (COVID-19) requiring intensive care hospitalization: a longitudinal observational study

The use of methylprednisolone in patients with Coronavirus disease 2019 (COVID-19) requiring intensive care hospitalization: a longitudinal observational study. Background : For a long time, the use of corticosteroids in critically ill patients with coronavirus disease 2019 (COVID-19) has been a controversial treatment. How- ever, given the conflicting evidence on this topic, we studied the effects of methylprednisolone on critically ill patients and - share here our experience on laboratory findings and the Pa02/FiO2 ratio (ratio of partial oxygen concentration on arterial blood gas sample to fraction of inspired oxygen). Methods : In a population of 68 patients hospitalized in the intensive care unit due because of COVID-19 infection, 28 patients with severe respiratory failure received methylprednisolone on a fixed 12-day regimen (125 mg IV for 2 days, followed by 2x0.5 mg/kg IV twice daily for 5 days, and then a decreasing regimen for 4 days until discontinuation). After day 5 and day 10, we analyzed the levels of CRP (C-reactive protein), lymphocytosis, D-dimer, LDH (lactate dehydrogenase) and PaO 2 /FiO 2 ratio of our patients. Results : We observed a significant decrease in median CRP levels between day 0 (start of methylprednisolone treatment) and day 5 (p=0.001), and between day 0 and day 10 (p=0.005). No decrease was seen between day 5 and 10 (p=0.352). The same increase in PaO 2 /FiO 2 was recorded between day 0 and day 5 (p=0.009), and between 0 and day 10 (p=0.019). For D-dimer, only a significant difference was found between day 0 and day 10 (p=0.018). No significant difference could be observed for lymphocytosis and LDH levels between the beginning of the treatment and day 5 or day 10. Conclusion : There is a strong and sustained significant decrease in CRP levels and a tilt in the PaO2/FiO2 ratio after starting methylprednisolone. A slower, but also significant decrease was found for D-dimer. Further research and control group analyses are needed to confirm that this effect is due to corticostreoid treatment. However, this indicates that methylprednisolone may play a very important role in the treatment of the severely ill COVID-19 patients requiring ICU admission.

The use of methylprednisolone in COVID-19 patients: A propensity score matched retrospective cohort study.

To evaluate the efficacy and safety of methylprednisolone in treating the coronavirus disease 2019 (COVID-19) patients. A retrospective cohort study was conducted, and all COVID-19 patients were recruited who were admitted to the Yichang Third People's Hospital from February 1st to March 31st, 2020. One-to-one propensity score matching (PSM) was used for minimizing confounding effects. The primary outcome was hospital mortality, with the secondary outcomes being the time needed for a positive SARS-CoV-2 nucleic acid test to turn negative and the length of hospital stay. Totaling 367 patients with COVID-19 hospitalized at the Yichang Third People's Hospital were identified, of whom 276 were mild or stable COVID-19, and 67 were serious or critically ill. Among them, 255 patients were treated using methylprednisolone, and 188 did not receive any corticosteroid-related treatment. After PSM, no statistically significant difference was found in the baseline characteristics between the two groups. Regarding the outcomes, there also were no statistically significant difference between the two groups. Patients without the use of methylprednisolone were more quickly to obtain negative results of their nasopharyngeal swab tests of SARS-CoV-2 nucleic acid after treatment, compared to those receiving methylprednisolone. Methylprednisolone could not improve the prognosis of patients with COVID-19, and the efficacy and safety of the use of methylprednisolone in patients with COVID-19 still remain uncertain, thus the use of corticosteroids clinically in patients with COVID-19 should be with cautions.

Comparative analysis of the effect of steroid therapy and blood pressure maintenance on the mid-term outcomes of spinal cord injury

Objective. To analyze the dynamics of neurological symptoms and the structure of complications when using methylprednisolone and the method of maintaining target values of mean arterial pressure during surgical treatment of patients in the acute period of spinal cord injury (SCI). Material and Methods. The study included 110 patients in the acute period of SCI with compression of spinal cord segments who were admitted to the clinic from January 2012 to March 2018 and underwent decompression and stabilization surgery within the first 2–3 hours after admission. In order to improve the blood supply to the damaged segments of the spinal cord and to prevent multiple organ failure, the main direction of intensive care in two groups of patients was to maintain the target blood pressure at the level of 85–90 mm Hg during the first 7–10 days. The MPD group included 43 patients who received methylprednisolone as a neuroprotector at a dose of 30 mg/kg bolus within the first hour after admission, followed by infusion at a dose of 5.4 mg/kg/h for 23 hours; and the MAP group included 67 patients who did not receive methylprednisolone. Non-invasive monitoring of central hemodynamic parameters was carried out on the basis of impedance cardiography data. The objective status of patients and data of X-ray diagnostics at the time of preoperative examination and during instrumental studies, as well as in 3–14 day intervals and in the mid-term (up to 4–6 months) postoperative period were analyzed. Results. In the MPD group, 22 patients had ASIA type A neurological deficit, and an increase in ASIA grade was observed only in 4 (18 %) of them. There were 18 patients with incomplete injury in this group, and 9 of them (50 %) had a positive trend. In the MAP group, 38 patients had ASIA type A, out of them 11 (29 %) improved, and 28 patients had ASIA type B, C or D, out of them 17 (61 %) showed positive dynamics of neurological symptoms. No statistically significant differences were found. In the MPD group, complications such as nosocomial pneumonia and acute endobronchitis were observed three times more often, pulmonary embolism and decubital soft tissue ulcers – four times more often, and sepsis, acute respiratory distress syndrome and surgical site infection – two times more often. There were statistically significant differences in the incidence of nosocomial pneumonia and acute endobronchitis between MPD and MAP groups (p = 0.004 and p = 0.002, respectively.) Conclusion. Maintaining mean arterial pressure at 85–90 mm Hg during the first 7–10 days after admission to the hospital allowed achieving a greater number of cases of improvement in the neurological status of patients, in contrast to the use of methylprednisolone. The use of methylprednisolone in patients with acute SCI increased the risk of nosocomial pneumonia or acute endobronchitis by 2.91 times (p = 0.003).

Early complications of high-dose methylprednisolone in acute spinal cord injury patients

To evaluate the early complications and effect on neurological outcome of methylprednisolone (MP) treatment in spinal cord injury (SCI) patients during the acute phase. We retrospectively reviewed the whole cohort of patients admitted to our ICU between January 1994 and December 2005 due to acute SCI. Patients were grouped according to the medical treatment received (MP group versus no-MP group). Patient data as age, gender, Glasgow coma score (GCS), APACHE II, injury severity score (ISS) and ICU stay were recorded. Outcome at ICU discharge and neurological function based on Frankel grade was recorded at ICU admission and at ICU discharge. Early complications were also noted. There were no differences between both groups in ICU mortality (OR=0.48; 95% CI: 0.08-3.64) nor neurological function at ICU discharge. (OR=1.09; 95% CI: 0.35-3.66). MP group presented an increase in respiratory tract infections (OR=8.19; 95% CI: 1.10-358.6) and in total infections (OR=4.90; 95% CI: 1.46-18.83) compared to no-MP group during the ICU stay. There was a significant increase in the incidence of hyperglycaemia in the MP group (OR=17.0; 95% CI: 4.52-66.3). The use of MP in patients with acute SCI is not associated with an improvement in outcome or neurological function at ICU discharge. Moreover, the use of MP is associated with an increased risk of infectious and metabolic complications during ICU stay.

Methylprednisolone in acute spinal cord injuries.

Methylprednisolone is the only neuroprotective therapy advocated in acute non-penetrating spinal cord injury. Trials indicate improved neurological outcome following early administration of a high dose regime. The National Spinal Injuries Unit (NSIU) has promoted this regime by a simple laminated poster sent to all Irish A&E departments. To assess the use of methylprednisolone in patients with spinal cord injuries. A retrospective audit of patient data for all patients admitted with traumatic neurological impairment over a 12-month period. One hundred ninety-six patients were admitted during the study period, 28 (14%) received intravenous methylprednisolone of which six had clear records documenting compliance. One patient received both dexamethasone and methylprednisolone in high doses and three had incorrect bolus dosages administered. Six patients received methylprednisolone infusion longer than the protocol, while five patients were given infusions shorter than recommended. Three patients were admitted to the unit that could have received the steroid regime at the point of transfer. There was poor documentation of prescription orders and timing of administration. Only six patients had clear documentation allowing confirmation of adherence to the protocol of the National Acute Spinal Cord Injury Study (NASCIS) III trial.

Use of Methylprednisolone in Patients following Acute Myocardial Infarction: Hemodynamic and Metabolic Effects

Hemodynamic and metabolic effects of methylprednisolone were investigated in a double-blind study of 28 patients with acute myocardial infarction (AMI), confirmed by unequivocal electrocardiographic and enzyme changes. Measurements were performed prior to and at 1.5, 3, 4, 4.5, 12 and 24 hours following infusion of methylprednisolone (13 patients) or placebo (15 patients). Although systemic vascular resistance decreased from 1,750 to 1,420 dynes . sec . cm-5 (p less than .001) and cardiac index increased from 2.77 to 3.10 L/min/m2 (p less than .02) between 0 and 4.5 hours, an abnormal increase in blood lactate was observed in 10 of the 13 patients following administration of methylprednisolone (3.0 vs 1.2 mM/L, p less than .001). Lactate elevation appeared one hour after infusion of methylprednisolone, was maximal at 12 hours, and persisted for more than 24 hours. There was no significant change in blood lactate in placebo treated patients. A transient but significant decrease in plasma volume was also observed following infusions of methylprednisolone. The elevation of blood lactate could not be explained by the reduction in plasma volume since the most striking increases in lactate were observed 12 hours following the initial infusion of methylprednisolone when the plasma volume was returning to the control value. No significant differences in other hemodynamic or metabolic parameters, infarct size or patient survival were observed between the two groups. We conclude that the hemodynamic benefits of glucocorticoids characterized by increased cardiac output and lowered systemic vascular resistance are counterbalanced by the potentially unfavorable conditions of lactate elevation and volume depletion.