Low-Dose Versus High-Dose Methylprednisolone and Impact on Duration of Noninvasive Bilevel Positive Airway Pressure in Pediatric Severe Asthma Exacerbations.

Abstract

Objective: Corticosteroids are frequently used in asthma exacerbation management; however, there are few data on optimal dosing for patients needing positive pressure ventilation. The purpose of this study is to investigate the relationship between steroid dosing and asthma outcomes, specifically as it relates to patients admitted to the pediatric intensive care unit (PICU) who require noninvasive bilevel positive airway pressure (NBPAP) ventilation.

Methods: This retrospective study evaluated patients older than 2 years, admitted to the PICU and initiated on NBPAP for an asthma exacerbation during the study period. The methylprednisolone low-dose (0.5 mg/kg/dose with a maximum of 15 mg every 6 hours) and high-dose (1 mg/kg/dose with a maximum of 60 mg every 6 hours) strategies were used to determine the cohorts. The NBPAP duration and PICU and hospital length of stay were recorded.

Results: A total of 197 patients were included in the study: 95 patients made up the low-dose cohort and 102 patients were in the high-dose cohort. The patients in the low-dose cohort had a median time on NBPAP of 25.2 hours compared with 25.5 hours in the high-dose cohort (p = 0.949). There was also no -difference in PICU and hospital length of stay as well as inpatient steroid duration.

Conclusions: No difference was observed between low-dose and high-dose methylprednisolone on -duration of NBPAP in pediatric severe asthma exacerbations.