Document Type

Poster

Publication Date

4-18-2024

Abstract

Background: Many critically ill children receive glucocorticoids (GCs), especially to treat pressor-resistant hypotension, but GCs may increase all-cause mortality. We will identify factors that contribute to GC exposure in PICU and NICU patients, determine the range of doses used, and develop guidelines for GC use in this population.

Methods: Phase 1 of this study is a retrospective chart review to identify factors that contribute to GC exposure in PICU and NICU patients and determine the range of doses used, (expressed as hydrocortisone equivalents/m2/d (HC equiv/m2/d)). The data will be used to develop guidelines for the use of GCs in this population, followed by Phase 2, a prospective review to determine the efficacy of the new guidelines. ANOVA, t-tests, and multivariate regression analysis will be used.

Results: From 240 charts, 43 patients reported home GC doses >10mg/m2/d HC equiv, and 35 received >20mg/m2/d; of these, 35% received any GC in the ED. Of all patients who received any GC in the ED, doses ranged from 13.3 to 555.6 mg/m2 HC equiv (single dose), and 51% had a primary respiratory diagnosis. Patients with a “respiratory failure” received lower single doses (117 +/- 102 mg/m2 HC equiv) than patients with “asthma exacerbation” (189 +/- 90.1 mg/m2 HC equiv); the difference was not significant (p = 0.065).

Discussion: Based on our preliminary analysis, steroids are predominantly administered for respiratory illness in the ED with a wide single dose range. We expect to observe similar variation in the doses administered in the PICU. Additionally, many patients who are likely to have adrenal suppression (those receiving >20mg/m2/d HC equiv at home) did not receive stress dose GC when presenting with acute illness to the ED. These results suggest a potential area of improvement.

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