Rebound Hypoxemia in Mechanically Ventilated Patients With COVID-19 Completing a Standard 10-Day Course of Corticosteroid Therapy.
Background: Rebound hypoxemia may occur after cessation of corticosteroid therapy for COVID-19 pneumonitis. We aimed to determine the incidence of this phenomenon in mechanically ventilated patients with COVID-19 completing corticosteroid therapy. Methods: We conducted a retrospective observational...
| Publicado en: | Respiratory Care Vol. 70; no. 8; pp. 987 - 995 |
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| Autores principales: | , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Aug2025
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=187150237&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 187150237 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Aug2025 vid: 70 iid: 8 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 187150237 187150237 187150237 10.1089/respcare.12494 187150237 ppf: 987 ppct: 8 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Rebound Hypoxemia in Mechanically Ventilated Patients With COVID-19 Completing a Standard 10-Day Course of Corticosteroid Therapy. aug: au: Costa-Pinto, Rahul Rotherham, Hannah O'Brien, Zachary Perera, Padeepa Chen, Vicky Massarany, Christopher Xu, Brett Bellomo, Rinaldo affil: Drs. Costa-Pinto, Massarany, Xu and Prof. Bellomo are affiliated with Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia. sug: subj: Anoxemia Epidemiology COVID-19 Complications COVID-19 Respiration, Artificial Glucocorticoids Therapeutic Use Dexamethasone Therapeutic Use Dexamethasone Administration and Dosage Treatment Duration Treatment Outcomes Evaluation Human Male Female Retrospective Design Record Review Nonexperimental Studies Tertiary Health Care Australia Descriptive Statistics Data Analysis Software Wilcoxon Rank Sum Test Pearson's Correlation Coefficient Chi Square Test Fisher's Exact Test Organizing Pneumonia C-Reactive Protein Treatment Withdrawal Oxygen Saturation Intensive Care Units Male Female ab: Background: Rebound hypoxemia may occur after cessation of corticosteroid therapy for COVID-19 pneumonitis. We aimed to determine the incidence of this phenomenon in mechanically ventilated patients with COVID-19 completing corticosteroid therapy. Methods: We conducted a retrospective observational cohort study across 2 tertiary ICUs from September to December 2021. We included all adult patients receiving invasive mechanical ventilation on completion of a 10-day course of dexamethasone for COVID pneumonitis. Our primary outcome was change in PaO2/FIO2 ratio in the 7 days following cessation of dexamethasone. Secondary outcomes included duration of ventilation, frequency of corticosteroid recommencement, and mortality. Results: We studied 88 subjects. Median age was 61 years (interquartile range [IQR] 51–67), and median duration of mechanical ventilation was 14 days (IQR 11–26). On completion of dexamethasone, 62 subjects (70%) remained off corticosteroid therapy for the subsequent 7 days. Of these, 63% (n = 20) had a stable PaO2/FIO2 ratio on day 7 (mean change 197 ± 42 mm Hg to 258 ± 83 mm Hg). Subjects who had a reduction in PaO2/FIO2 ratio >20 mm Hg by day 7 (mean change 214 ± 68 mm Hg to 152 ± 78 mm Hg) were more likely to die in hospital (P <.001). These subjects had a higher C-reactive protein level at time of steroid cessation (204 ± 87 mg/L, P =.17), which remained persistently elevated (206 ± 89 mg/L, P =.01) on day 7. The 30% of subjects who recommenced steroids required a longer duration of ventilation (13.5 vs 24.5 d, P =.002) but showed no differences in ICU mortality (19% vs 27%, P =.43). Conclusions: Rebound hypoxemia and steroid recommencement were common occurrences in mechanically ventilated subjects with COVID-19. Rebound hypoxemia was associated with higher mortality. Steroid recommencement was associated with longer duration of mechanical ventilation but no significant difference in mortality. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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