The purpose of this study was to analyze the efficacy of
corticosteroids in severe acute decompensation of
chronic obstructive pulmonary disease requiring
mechanical ventilation and intensive care unit (ICU) admission. Pairwise retrospective case-control study with 1:1 matching. Patients were defined as cases when they received
corticosteroids and as controls when they did not received any
steroids. Patients were matched according to age, severity factors at admission represented by the PaO2/FiO2 ratio, and simplified acute physiology score. Thirty-four patients were included. There were 17 patients in the case group and 17 patients in the control group. There were 27 men (80%) and 7 women (20%). The mean age (±SD) was 70 ± 9 years with a range of 40-85 years. Thirty-two patients (94 %) were older than 60 years. The comparison between the 2 groups showed that they had the same epidemiological, clinical, and
biological findings on ICU admission. Homodynamic parameters were also not significantly different between the 2 groups. Moreover, there is the same proportion of invasive
mechanical ventilation use in 2 groups. Concomitant drugs used were also not significantly different between the 2 groups. Finally, the comparison of outcome between the
steroid and
steroid-free groups showed that mortality rate was not significantly different (64% vs. 58%, P = 0.72). However, systemic
corticosteroid therapy was associated with a significant increase in a reduction in the duration of
mechanical ventilation (P = 0.004) and a trend toward a shorter length of ICU stay (P = 0.053). Although the authors detected no significant difference in mortality rate at the time of discharge between
steroid and streroid-free patients, this study confirms that systemic
corticosteroid therapy in patients with
chronic obstructive pulmonary disease exacerbations requiring
mechanical ventilation is associated with a significant reduction in the duration of
mechanical ventilation. Other studies are needed on this subject.