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Canadian Respiratory Journal - Volume 22 2015, Issue 5, Pages 271-274

Original Article

Centre de Recherche Clinique du Centre Hospitalier Universitaire de Sherbrooke CRCHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada

Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada

Department of Microbiology & Infectious Diseases, Université de Sherbrooke, Sherbrooke, Sherborooke, Quebec, Canada

Trauma, Emergency & Critical Care Program, Sunnybrook Health Sciences Centre, Canada

Toronto Invasive Bacterial Diseases Network; Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada

Department of Medicine, Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada

Copyright © 2015 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: Survey data suggest that Canadian intensivists administer corticosteroids to critically ill patients primarily in response to airway obstruction, perceived risk for adrenal insufficiency and hemodynamic instability.

OBJECTIVE: To describe variables independently associated with systemic corticosteroid therapy during an influenza outbreak.

METHODS: The present analysis was retrospective cohort study involving critically ill patients with influenza in two Canadian cities. Hospital records were reviewed for critically ill patients treated in the intensive care units ICUs of eight hospitals in Canada during the 2008 to 2009 and 2009 to 2010 influenza outbreaks. Abstracted data included demographic information, symptoms at disease onset, chronic comorbidities and baseline illness severity scores. Corticosteroid use data were extracted for every ICU day and expressed as hydrocortisone dose equivalent in mg. Multivariable regression models were constructed to identify variables independently associated with corticosteroid therapy in the ICU.

RESULTS: The study cohort included 90 patients with a mean ± SD age of 55.0±17.3 years and Acute Physiology and Chronic Health Evaluation II score of 19.8±8.3. Patients in 2009 to 2010 were younger with more severe lung injury but similar exposure to corticosteroids. Overall, 54% of patients received corticosteroids at a mean daily dose of 343±330 mg of hydrocortisone for 8.5±4.8 days. Variables independently associated with corticosteroid therapy in the ICU were history of airway obstruction OR 4.8 95% CI 1.6 to 14.9 and hemodynamic instability OR 4.6 95% CI 1.2 to 17.8.

CONCLUSION: Observational data revealed that hemodynamic instability and airway obstruction were associated with corticosteroid therapy in the critical care setting, similar to a recent survey of stated practice. Efforts to determine the effects of corticosteroids in the ICU for these specific clinical situations are warranted.

Autor: Philippe Yale, Neill KJ Adhikari, Vincent Masse, Robert A Fowler, Wei Xiong, Allison McGeer, Darlene Cann, Wallis Rudnick, Karen



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