Mode of methylprednisolone administration and its influence on ARDS dynamics in treatment of hospitalized COVID‑19 patients

Abstract

Introduction. Glucocorticoids are used worldwide to control hyperinflammation in hospitalized COVID‑19 patients. Nevertheless, the debate on the appropriate initiation time, effective treatment duration and modes of administration is still ongoing.The aim of this retrospective group analysis was to evaluate the influence of early methylprednisolone (MP) administration mode on acute respiratory distress syndrome (ARDS) dynamics in patients with COVID‑19.Materials and methods. We performed a retrospective analysis of 61 patients, who received MP treatment in the infection unit of our institution. The patients were retrospectively grouped by the MP administration method: either pulse boluses (group 1), or initial loading bolus followed by continuous infusion (group 2). MP administration was initiated on day 3–4 after hospital admission, i. e., within the first 10 days of the manifestation of symptoms. This is an earlier corticoid administration start, than is being described in most publications.Results. The positive dynamics in the setting of MP therapy was more pronounced in the continuous infusion group. Intensive care unit (ICU) transfer was necessary for 10 patients (33.3 %) of group 2 and for almost twice as many (19 patients, 61.2 %) of group 1. Patients of group 1 required respiratory support escalation (to mechanical lung ventilation) more often. Overall survival at hospital discharge was 77.5 % in the bolus group (group 1) and 90.0 % in the continuous infusion group (group 2).Conclusion. Based on our experience and the results of statistical analysis, the early use of MP (within 10 days of the first symptoms manifestation) in the ‘bolus followed by continuous infusion’ mode in the setting of the infection unit may reduce disease severity, decrease the need for respiratory support escalation, lower the number of cases of non-invasive and invasive lung ventilation and increase survival of COVID‑19 patients. These results must be further studied in randomized controlled studies.