title: Efficacy of corticosteroid therapy in patients with an acute exacerbation of chronic obstructive pulmonary disease receiving ventilatory support.
abstract: 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).
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01281748.
authors: Intensive Care Units, Hospital Universitario de Getafe, Centros de Investigacion Biomedica en Red Enfermedades Respiratorias, Getafe, Spain.
authors: Inmaculada
authors: I
authors: Alía
authors: Miguel A
authors: MA
authors: de la Cal
authors: Andrés
authors: A
authors: Esteban
authors: Ana
authors: A
authors: Abella
authors: Ricard
authors: R
authors: Ferrer
authors: Francisco J
authors: FJ
authors: Molina
authors: Antoni
authors: A
authors: Torres
authors: Federico
authors: F
authors: Gordo
authors: José J
authors: JJ
authors: Elizalde
authors: Raúl
authors: R
authors: de Pablo
authors: Alejandro
authors: A
authors: Huete
authors: Antonio
authors: A
authors: Anzueto
mesh_terms: D000368:Aged; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D001786:Blood Glucose / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000139:chemically induced; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008775:Methylprednisolone / Q000009:adverse effects*; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000188:drug therapy*; D012121:Respiration, Artificial
chemical_list: D000893:Anti-Inflammatory Agents; D001786:Blood Glucose; D008775:Methylprednisolone