A55-29 Real-world Patterns of Corticosteroid Use in ARDS: Post-pandemic Insights From a Single-center Study

Abstract Rationale Corticosteroids are increasingly recommended for adult acute respiratory distress syndrome (ARDS). However, their optimal regimen—particularly regarding type, dose, and duration—has not been clearly established. Although dexamethasone has been established as a standard of care for COVID-19-related ARDS, evidence regarding corticosteroid therapy in non-COVID-19 ARDS remains inconsistent. In the post-COVID-19 era, understanding how corticosteroids are used in real-world settings is crucial for bridging the gap between evolving guidelines and clinical practice. This study aimed to characterize corticosteroid use patterns and clinical features among ARDS patients at a tertiary care hospital in Japan. Methods We retrospectively reviewed the medical records of adult patients diagnosed with ARDS according to the Berlin definition who were admitted to Saiseikai Utsunomiya Hospital between January 2021 and December 2023. Demographic data, ARDS etiology, steroid type and dosage, duration of therapy, and in-hospital outcomes were extracted and analyzed. Descriptive statistics were used to summarize treatment trends. Results A total of 92 patients met the diagnostic criteria for ARDS. The median age was 68 years (IQR 55-76), and 68 (73.9%) were male. The median duration of mechanical ventilation was 15.0 days (IQR 2-160), and the median ICU length of stay was 15.5 days (IQR 2-100). The overall hospital survival rate was 59.7%. Major etiologies included COVID-19 pneumonia (n = 31), aspiration pneumonia (n = 15), and bacterial pneumonia (n = 12). Overall, 75 patients (81.5%) received corticosteroid therapy. Hydrocortisone 200-400 mg/day was the most frequently administered regimen (35 patients, 38.0%), followed by dexamethasone 6.6 mg/day (27 patients, 29.3%), and methylprednisolone pulse therapy at 1,000 mg/day (7 patients, 7.6%). When analyzed by etiology, among patients with COVID-19-related ARDS, dexamethasone was the predominant regimen, administered in most cases (27 patients, 87.1%). In contrast, among patients with bacterial or aspiration pneumonia-related ARDS, including those without an identified pathogen, hydrocortisone was most frequently used (21 patients, 56.8%). Conclusions More than four-fifths of ARDS patients at our institution received corticosteroids, but treatment strategies varied considerably depending on etiology. In COVID-19 cases, dexamethasone was predominantly used, reflecting the influence of international treatment guidelines, whereas non-COVID-19 ARDS showed greater variability in corticosteroid regimens. Further studies are needed to clarify optimal approaches to corticosteroid use in ARDS with diverse etiologies. This abstract is funded by: None