Abstract
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.
Get full access to this article
View all access options for this article.
References
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
