The use of low dose methylprednisolone in severe Covid-19 induced ARDS to facilitate oxygen weaning: Results from a case series and mini review

We describe 8 patients with confirmed Covid-19 infection requiring high flow oxygen and respiratory support for adult Respiratory distress syndrome (ARDS) for a mean duration of 12 days. These patients had already received standard treatments for Covid-19, including broad spectrum antibiotics, dexamethasone, heparin and remdesivir along with entry to the recovery trial according to patient choice. Due to on-going high oxygen demands and respiratory support, these patients were at increasing risk of significant lung injury and the development of fibrotic lung changes. Intravenous low dose methylprednisolone was therefore given in an attempt to assist resolution of the ARDS. The low dose was chosen to reduce the cytokine storm and minimise the risk of a super-infection. This led to improvement in 6 out of 8 patients allowing oxygen weaning (mean duration 4.5 days) and discharge home within a mean duration of 11 days. Five patients were discharge home with low flow oxygen (mean 2.8 L/min) with community based weaning. The 2 non-responders subsequently deteriorated further and were managed palliatively. We describe the cases and discuss the current literature with regard to the use of methylprednisolone in Covid-19 ARDS.