Efficacy of Corticosteroid Therapy in Patients With an Acute Exacerbation of Chronic Obstructive Pulmonary Disease Receiving Ventilatory Support
Efficacy of Corticosteroid Therapy in Patients With an Acute Exacerbation of Chronic Obstructive Pulmonary Disease Receiving Ventilatory Support
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DOI：
10.1001/archinternmed.2011.530
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发表时间：
2011-11-28
影响因子：
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通讯作者：
Anzueto, Antonio
中科院分区：
文献类型：
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作者：
Alia, Inmaculada;de la Cal, Miguel A.;Anzueto, Antonio
背景资料：评估全身性皮质类固醇对慢性阻塞性肺疾病（COPD）急性加重的影响的随机试验排除了机械通气或入住重症监护室（ICU）的患者。危重病患者是一群容易发生并发症的人群，这些并发症可能与皮质类固醇的使用有关（如感染、高血糖、ICU获得性轻瘫），可能延长机械通气时间，甚至增加死亡率。方法：双盲安慰剂-进行对照试验，以评估全身性皮质类固醇治疗在接受治疗的COPD急性加重患者中的疗效和安全性呼吸支持（有创或无创机械通气）。从2005年7月至2009年7月，共筛选了4个国家8家医院ICU收治的354例成人患者，其中83例随机接受静脉注射甲基强的松龙（0.5 mg/kg，每6小时一次，持续72小时，第4天至第6天每12小时一次0.5 mg/kg，第7天至第10天0.5 mg/kg/d）或安慰剂。主要结果指标为机械通气持续时间，ICU住院时间，以及无创机械通气治疗患者是否需要插管。结果：两组在人口统计学、疾病严重程度、COPD加重原因、气体交换变量和皮质类固醇抢救治疗方面无显著差异。皮质类固醇治疗与机械通气的中位持续时间显著缩短相关（3天vs 4天; P= 0.04），ICU住院时间中位数有缩短的趋势（6天vs 7天; P= 0.09），NIV失败率显著降低（0% vs 37%; P= 0.04）。在需要机械通气的COPD急性加重患者中，全身皮质类固醇治疗与无创机械通气成功率的显著增加和在机械通气期间
Background: Randomized trials assessing the effect of systemic corticosteroids on chronic obstructive pulmonary disease (COPD) exacerbations excluded patients who were mechanically ventilated or admitted to the intensive care unit (ICU). Critically ill patients constitute a population of persons who are prone to develop complications that are potentially associated with the use of corticosteroids (eg, infections, hyperglycemia, ICU-acquired paresis) that could prolong the duration of mechanical ventilation and even increase mortality.Methods: A double-blind placebo-controlled trial was conducted to evaluate the efficacy and safety of systemic corticosteroid treatment in patients with an exacerbation of COPD who were receiving ventilatory support (invasive or noninvasive mechanical ventilation). A total of 354 adult patients who were admitted to the ICUs of 8 hospitals in 4 countries from July 2005 through July 2009 were screened, and 83 were randomized to receive intravenous methylprednisolone (0.5 mg/kg every 6 hours for 72 hours, 0.5 mg/kg every 12 hours on days 4 through 6, and 0.5 mg/kg/d on days 7 through 10) or placebo. The main outcome measures were duration of mechanical ventilation, length of ICU stay, and need for intubation in patients treated with noninvasive mechanical ventilation.Results: There were no significant differences between the groups in demographics, severity of illness, reasons for COPD exacerbation, gas exchange variables, and corticosteroid rescue treatment. Corticosteroid treatment was associated with a significant reduction in the median duration of mechanical ventilation (3 days vs 4 days; P=.04), a trend toward a shorter median length of ICU stay (6 days vs 7 days; P=.09), and significant reduction in the rate of NIV failure (0% vs 37%; P=.04).Conclusion: Systemic corticosteroid therapy in patients with COPD exacerbations requiring mechanical ventilation is associated with a significant increase in the success of noninvasive mechanical ventilation and a reduction in the duration of mechanical ventilation