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J Crit Care. 2013 Dec;28(6):985-91. doi: 10.1016/j.jcrc.2013.08.011. Epub 2013 Sep 24.

Prehospital use of inhaled steroids and incidence of acute lung injury among patients at risk.

Author information

1
Division of Pulmonary Medicine and Department of Critical Care, Mayo Clinic, Jacksonville, FL. Electronic address: festic.emir@mayo.edu.

Abstract

PURPOSE:

Inhaled corticosteroids (ICSs) attenuated lung injury in animal studies. We investigated the association between prehospital ICS and incidence of acute lung injury (ALI) among patients at risk.

METHODS:

In this ancillary analysis of the large multicenter Lung Injury Prediction Study cohort, we developed a propensity score for prehospital ICS use followed by matching, for all patients and for a subgroup of patients with at least 1 risk factor for direct pulmonary injury. The primary outcome was ALI; secondary outcomes included acute respiratory distress syndrome, need for invasive mechanical ventilation, and hospital mortality.

RESULTS:

Of the 5126 patients, 401 (8%) were using ICS. Acute lung injury developed in 343 (7%). The unadjusted incidence of ALI was 4.7% vs 6.9% (P = .12) among those in ICS compared with non-ICS group. In the "direct" lung injury subgroup, the unadjusted incidence of ALI was 4.1% vs 10.6% (P = 0.006). After propensity matching, the estimated effect for ALI in the whole cohort was 0.69 (95% confidence interval, 0.39-1.2; P = .18), and that in the direct subgroup was 0.56 (95% confidence interval, 0.22-1.46; P = .24).

CONCLUSIONS:

Preadmission use of ICS in a hospitalized population of patients at risk for ALI was not significantly associated with a lower incidence of ALI once controlled by comprehensive propensity-matched analysis.

KEYWORDS:

Acute lung injury; Acute respiratory distress syndrome; Corticosteroids; Inhaled steroids

PMID:
24075297
PMCID:
PMC4219561
DOI:
10.1016/j.jcrc.2013.08.011
[Indexed for MEDLINE]
Free PMC Article
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