Low Versus High Corticosteroid Use in Ventilator Associated Pneumonia
Condition: Ventilator Associated Pneumonia
MeSH terms: Pneumonia; Pneumonia, Ventilator-Associated
Study type: Interventional
Phase: Phase 2

Summary: 
      patients who had >3 on Murray score and >6 on CPIS allocated randomly in two groups 120
      patients in each. Group A received 30 mg/kg methyl-prednisolone slowly intravenous in 250 mL
      normal saline every 8 hours for only 48 hours while group B received 1 mg/kg/day
      methyl-prednisolone divided to three doses given every 8 hours for two weeks. Duration of the
      study last 16 days, Morbidity considered if no improvement in any or all clinical parameters
      of both Murray and CPIS scores and failure of weaning of patients from the ventilator at the
      studied period.
    

Detailed description: 
      Adult patients aged >18<65 years, hypercapnia with PH <7.25, hypoxic index less than 200
      (PaO2/FIO2), bilateral parenchymatous lung infiltration in the chest Xray. All selected
      patients received conventional ventilation with protective lung strategy for 3 days with
      Controlled mechanical ventilation mode (CMV), fraction inspired oxygen (FIO2) of 100%,
      Positive end expiratory pressure (PEEP) adjusted to achieve target arterial oxygen saturation
      (SPO2) of >90%. Sedation and pain control done by both midazolam and fentanyl infusion to
      achieve Richmond Agitation- Sedation Scale (RASS) -2. Protective lung strategy applied and
      include, head elevation more than 45-degree, daily assessment for both analgesic and sedative
      dose, early naso-gastric feeding to prevent bacterial translocation and flooding of the blood
      with gram negative septicemia, usage of the minimal PEEP to maintain SPO2 >90%. Qualitative
      sputum culture was taken after 3 days from ventilation. After 3 days from the conventional
      ventilation only 240 patients enrolled in our study. Those who had a Murray score (for
      diagnosis of ARDS) of >3 and CPIS (clinical pulmonary infection score) (for diagnosis of VAP)
      > 6. All patients were randomly allocated in 2 groups 120 patients in each. All patients
      received intravenous antibiotics meropenem 1 gm slowly intravenous every 8 hours for the
      first 8 days then antibiotics was given according to sputum culture and antibiotics
      sensitivity. Group A received high dose (30 mg/kg) methylprednisolone slowly intravenous in
      250 ml normal saline every 8 hours for only 4 days while group B included received 1
      mg/kg/day methylprednisolone divided to three doses given every 8 hours for two weeks. This
      study conducted for 16 days.

      VAP diagnosed in our study by CPIS 6 or more while severity of lung contusion assessed by
      Murray score 3 or more
    

Intervention name(s): methylprednisolone; Methyl Prednisolonate; ventilators
Intervention type(s): Drug; Drug; Device
Intervention description(s): received high dose (30 mg/kg) methylprednisolone slowly intravenous in 250 ml normal saline every 8 hours for only 4 days; received 1 mg/kg/day methylprednisolone divided to three doses given every 8 hours for two weeks.; all patients in both groups will be ventilated with CMV for 2 weeks
Intervention MeSH terms: Methylprednisolone; Methylprednisolone Acetate; Methylprednisolone Hemisuccinate; Prednisolone; Prednisolone acetate; Prednisolone hemisuccinate; Prednisolone phosphate
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Patients who had severe chest trauma with massive lung contusion and admitted to King Abdelaziz specialist hospital between January 2018 and February 2020 in the intensive care unit those who showed the following inclusion criteria of ARDS, respiratory failure due to severe lung contusion complicated by VAP enrolled in our study
Masking: None (Open Label)
Primary purpose: Treatment