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Inhaled Corticosteroids Use Before Hospitalization May Be Protective in Children With Direct Lung Injury.
Landzberg, Elizabeth; Keim, Garrett; Yehya, Nadir.
Afiliación
  • Landzberg E; Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA.
  • Keim G; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, the Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
  • Yehya N; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, the Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
CHEST Crit Care ; 2(2)2024 Jun.
Article en En | MEDLINE | ID: mdl-39301035
ABSTRACT

BACKGROUND:

Systemic corticosteroid use in acute respiratory failure has yielded uncertain benefits, partially because of off-target side effects. Inhaled corticosteroids (ICSs) confer localized antiinflammatory benefits and may protect adults with direct lung injury (DLI) from developing respiratory failure. To our knowledge, this relationship has not been studied in children. RESEARCH QUESTION Do children with DLI who are prescribed ICSs before hospitalization have lower odds of progressing to respiratory failure? STUDY DESIGN AND

METHODS:

This retrospective, single-center cohort identified children seeking treatment at the ED with DLI and medication records before hospitalization. The primary outcome was intubation; secondary outcomes included noninvasive respiratory support (NRS). We tested the association of ICSs with intubation and NRS, adjusting for confounders. We stratified analyses on history of asthma and performed a sensitivity analysis adjusting for systemic corticosteroid use to account for status asthmaticus.

RESULTS:

Of 35,220 patients, 17,649 patients (50%) were prescribed ICSs. Intubation occurred in 169 patients (73 patients receiving ICSs) and NRS was used in 3,582 patients (1,336 patients receiving ICS). ICS use was associated with lower intubation (adjusted OR, 0.46; 95% CI, 0.31-0.67) and NRS (aOR, 0.45; 95% CI, 0.40-0.49). The association between ICS and NRS differed according to history of asthma (P = .04 for interaction), with ICS exposure remaining protective only for patients with a history of asthma. Results held true in sensitivity analyses.

INTERPRETATION:

ICS use prior to hospitalization may protect children with DLI from progressing to respiratory failure, with possible differential efficacy according to history of asthma.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: CHEST Crit Care Año: 2024 Tipo del documento: Article País de afiliación: Panamá Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: CHEST Crit Care Año: 2024 Tipo del documento: Article País de afiliación: Panamá Pais de publicación: Estados Unidos