Methylprednisolone may be associated with improved lung compliance in acute respiratory distress syndrome patients on veno-venous extracorporeal membrane oxygenation

[tetano]

Perfusion. 2020 Feb 19:267659120906044. doi: 10.1177/0267659120906044. [Epub ahead of print] Methylprednisolone may be associated with improved lung compliance in acute respiratory distress syndrome patients on veno-venous extracorporeal membrane oxygenation.

Tabatabai A¹, Menaker J¹, Stene E¹, Kufera JA¹, Rabinowitz RP¹, Kon Z², Herr DL¹, Scalea TM¹.
Author information

Abstract

INTRODUCTION:

Methylprednisolone has been used for acute respiratory distress syndrome with variable results. Veno-venous extracorporeal membrane oxygenation use in acute respiratory distress syndrome has increased. Occasionally, both are used. We hypothesized that methylprednisolone could improve lung compliance and ease weaning from extracorporeal membrane oxygenation in acute respiratory distress syndrome patients.
METHODS:

We retrospectively reviewed all patients in our veno-venous extracorporeal membrane oxygenation unit treated with methylprednisolone over a 20 month period. Methylprednisolone was initiated for inability to wean off veno-venous extracorporeal membrane oxygenation. Dynamic compliance (Cdyn) was calculated at cannulation, methylprednisolone initiation, and decannulation. Demographics, extracorporeal membrane oxygenation-specific data, and ventilator data were collected. Wilcoxon rank-sum test was used to test for differences in dynamic compliance.
RESULTS:

A total of 12 veno-venous extracorporeal membrane oxygenation patients received methylprednisolone. Mean age was 50 (?15) years. Seven had influenza. Methylprednisolone was started on median Day 16 (interquartile range: 11-22) of veno-venous extracorporeal membrane oxygenation. In total, 10 patients had veno-venous extracorporeal membrane oxygenation decannulation on median Day 12 (7-22) after methylprednisolone initiation. Two patients died before decannulation. The 10 decannulated patients had initial median dynamic compliance (mL ? cm H₂O^-1) of 12 (7-23), then 16 (10-24) at methylprednisolone initiation, and then 44 (34-60) at decannulation. Dynamic compliance was higher at decannulation than methylprednisolone initiation (p = 0.002), and unchanged from cannulation to methylprednisolone initiation for all patients (p = 0.97). A total of 10 patients had significant infections. None had significant gastrointestinal bleed or wound healing issues.
CONCLUSION:

Methylprednisolone may be associated with improved compliance in acute respiratory distress syndrome allowing for decannulation from veno-venous extracorporeal membrane oxygenation. High rates of infection are associated with methylprednisolone use in veno-venous extracorporeal membrane oxygenation. Further studies are required to identify appropriate patient selection for methylprednisolone use in patients on veno-venous extracorporeal membrane oxygenation.


KEYWORDS:

acute respiratory distress syndrome; extracorporeal membrane oxygenation; methylprednisolone; steroids; veno-venous extracorporeal membrane oxygenation

PMID: 32072859 DOI: 10.1177/0267659120906044

[kiwibird]

A caveat though;

February 3rd, 2020, 12:57 AM
Originally posted by Pathfinder View Post
Translation Google

Wuhan pneumonia death rate lower than SARS? Virus Expert: Not necessarily

A new coronavirus from Wuhan, China triggered a global panic. The previous news was that although the virus is highly contagious, the fatality rate is not as high as SARS in 2003. Domestic virus expert Su Yiren said that it is still too early to talk about the fatality rate. According to the data, the fatality rate of the new Wuhan virus is not necessarily lower than that of SARS.
........

Su Yiren also mentioned a special situation, saying that the SARS epidemic that year was high in Taiwan, but the mortality rate was high. Like in Vietnam at the time, patients were placed in a ventilated place and were not actively treated. The mortality rate was actually low. It was believed that steroids were given to patients in Taiwan at the time to rescue pulmonary fibrosis, but their immunity was reduced. At the same time, living in intensive care units also increased the risk of bacterial infection. Many patients died of infected sepsis. How to treat Wuhan pneumonia in the future needs to be discussed .

https://health.udn.com/health/story/120951/4318076

snip from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1904416/

"Summary of SARS cases with onset of illness from 1 November 2002 to 31 July 2003.¹²

Australia	6	2	4	15 (1–45)	0 (0)	1 (16)	26 Feb 03	1 Apr 03
Canada	251	100	151	49 (1–98)	43 (17)	109 (43)	23 Feb 03	12 Jun 03
China	5281	2607	2674	Pending	349 (6.6)	1002 (19)	16 Nov 02	3 Jun 03
Hong Kong	1755	778	977	40 (0–100)	299 (17)	386 (22)	15 Feb 03	31 May 03
Singapore	238	77	161	35 (1–90)	33 (14)	97 (41)	25 Feb 03	5 May 03
Taiwan	346	128	218	42 (0–93)	37 (11)	68 (20)	25 Feb 03	15 Jun 03
Others	221				13 (5.9)	44 (17)
Total	8098				774 (9.6)	1707 (21)

^*HCW = healthcare workers."

It would seem that Taiwan had a comparable success rate as other countries (note the China rate seems very low and formally ended as 7%). Did other countries offer steroid treatment and what was the relationship to recovery rate? Is this virus expert Su Yiren, previous Director of Taiwan Disease Control Agency, thinking that the steroids actually lower the immune system and cause a cytokine storm? I will see if I can find more information about their observations.As Director Su Yiren was Director at the time of the 2004 SARS outbreak perhaps this opinion is based in individual case observations????

This thread https://flutrackers.com/forum/forum/...d-relationship discusses this - including this post from AlaskaDenise "Steroids

Corticosteroid medications such as prednisone, often prescribed to reduce inflammation, can reduce calcium absorption [77-79] and impair vitamin D metabolism. These effects can further contribute to the loss of bone and the development of osteoporosis associated with their long-term use [78-79]" from this paper http://ods.od.nih.gov/factsheets/vitamind.asp#h7

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  #80.1
  kiwibird commented
  February 3rd, 2020, 01:03 AM
  From Pathfinders original post - and the quote from Director Su Yiren - this still brings us back to Tetano's post about the use of Antivirals and Antibiotics as a successful treatment.
  
  "At the same time, living in intensive care units also increased the risk of bacterial infection. Many patients died of infected sepsis. How to treat Wuhan pneumonia in the future needs to be discussed".
  
  I note that one of the first cases of SARS 2003/04 in Hong Kong was treated, appeared to be recovered, and was sent home to his apartment in Amoy Garden (which was a primary cross contamination point of the SARS epidemic) and then fell ill again. This appeared to be a bacterial infection combined with dual influenza a and sars infection and unfortunately he did not recover from this. from - https://pmj.bmj.com/content/80/945/373
  Last edited by kiwibird; February 3rd, 2020, 01:17 AM. Reason: dual infection info