title: Impact of steroid medication before hospital admission on barotrauma in mechanically ventilated patients with acute respiratory distress syndrome in intensive care units.
abstract: OBJECTIVE
  To investigate the association between steroid medication before hospital admission and barotrauma in mechanically ventilated patients with acute respiratory distress syndrome (ARDS).
  
  
  METHODS
  An observational single-center retrospective study was conducted using patients admitted to the general intensive care unit (ICU) of a university hospital in Japan. We analyzed 149 mechanically ventilated patients with ARDS hospitalized between March 2008 and March 2011. ARDS was identified according to criteria from the Berlin Definition. Barotrauma was defined as pneumothorax, subcutaneous emphysema, or mediastinal emphysema occurring during mechanical ventilation in the ICU. The influence of steroid medication before hospital admission on barotrauma was studied using multiple logistic regression analysis.
  
  
  RESULTS
  There were no differences in baseline patient characteristics except for congestive heart failure, peak pressure during mechanical ventilation, and steroid pulse therapy between the barotrauma and non-barotrauma groups. Logistic regression analysis showed that peak pressure ≥35 cmH2O was associated with barotrauma in patients with ARDS [odds ratio (OR), 17.34; P < 0.01], whereas steroid medication before hospital admission was not a significant factor for barotrauma (OR, 1.63; P = 0.51).
  
  
  CONCLUSIONS
  Barotrauma in ARDS patients was associated with higher pressure during mechanical ventilation but not with steroid medication before hospital admission.
authors.affiliation: Department of General Intensive Care Unit, Hirakata Hospital, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan, umegakit@hirakata.kmu.ac.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Umegaki
authors.forename: Sachiyo
authors.initials: S
authors.lastname: Sakamoto
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Nishi
authors.forename: Akihisa
authors.initials: A
authors.lastname: Okamoto
authors.forename: Aki
authors.initials: A
authors.lastname: Onose
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Hamano
authors.forename: Etsuko
authors.initials: E
authors.lastname: Yamazaki
authors.forename: Koh
authors.initials: K
authors.lastname: Shingu
mesh_terms: D000368:Aged; D001469:Barotrauma / Q000453:epidemiology*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006760:Hospitalization; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D007564:Japan / Q000453:epidemiology; D008297:Male; D008478:Mediastinal Emphysema / Q000453:epidemiology; D008875:Middle Aged; D011030:Pneumothorax / Q000453:epidemiology; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D012189:Retrospective Studies; D013352:Subcutaneous Emphysema / Q000453:epidemiology
chemical_list: D005938:Glucocorticoids