Acute Respiratory Distress Syndrome in ICU May Not Be Linked to Steroids

This article is part of Pulmonology Advisor’s coverage of the American Thoracic Society Virtual 2020 meeting.

Treatment with steroids within a 48-hour period after intubation in the intensive care unit (ICU) was not associated with the development of acute respiratory distress syndrome (ARDS), according to findings presented virtually at the American Thoracic Society (ATS) Virtual 2020 meeting, held from August 5 to 10, 2020.

Steroids modulate inflammation, a common component in ARDS. To determine whether steroids was associated with ARDS after 48 hours of intubation, researchers examined outcomes in 3370 patients who were intubated at 3 hospital ICUs between January 1, 2017, and August 31, 2018. Of these patients, 1042 (30.9%) were diagnosed with ARDS within the first 48 hours of intubation and were excluded from the analysis.

A multivariate logistic regression analysis was used to assess the association between the development of ARDS during the 48 hours after intubation and exposure to steroids. Cofounders included in the analysis were age, sex, race, sepsis, pneumonia, aspiration, and shock.

Approximately 27.2% (n=633) of the 2328 patients in the final sample were treated with steroids. A nonsignificantly higher percentage of patients exposed to steroids developed ARDS (10.1% vs 8.6%; odds ratio [OR], 1.2; 95% CI, 0.88-1.47; P =.25). Treatment with steroids was associated with a significantly higher mortality compared with treatment without steroids (21.2% vs 15.2%, respectively; OR, 1.48; 95% CI, 1.18-1.88; P <.001).

In the multivariate adjusted analysis, there was no association between steroid exposure and development of ARDS (adjusted OR [aOR], 0.72; 95% CI, 0.51-1.01) or mortality (aOR, 1.10; 95% CI, 0.84-1.45). Additionally, no significant association was observed between steroid exposure and ARDS development or mortality in patients with pneumonia (ARDS: aOR, 0.67; 95% CI, 0.44-1.02; mortality: aOR, 0.97; 95% CI, 0.65-1.45) vs without pneumonia (ARDS: aOR, 0.72; 95% CI, 0.40-1.32; mortality: aOR, 1.24; 95% CI, 0.85-1.81).

The researchers noted that most patients developed ARDS within 48 hours after intubation, and that 48 hours of steroids may not have been enough to prevent ARDS. In addition, there is a future study planned to determine the link between systemic steroid exposure before intubation and ARDS.

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Reference

Levitus M, Rosenzvit C, Yang K, et al. The effect of steroids within 48 hours of intubation and the development of acute respiratory distress syndrome. Presented at: American Thoracic Society 2020 Virtual; August 5-10, 2020. Abstract #P847.