Discussion
This was the first study to describe the efficacy of SPT for SOP due to
severe COVID-19. These cases are relatively elderly with some
comorbidities, similar as that of severe previous
cases5. The length of ICU stay in this study was
similar as that of Zhou et al6. It was reported that
the time to negative conversion of RT-PCR was 20 days in mild to severe
cases6,7. However, this study had it longer than that
of the previous study. It was suggested that systemic corticosteroids
might delay viral shedding. Since RT-PCR tests were not performed on
continuous days, the time to negative conversion of RT-PCR might be
shorter in some cases. One patient coexisted disuse syndrome, which
might be associated with systemic corticosteroids and bed rest for a
long time. However, it was significant that all patients could survive
without oxygen therapy. Therefore, SPT might be beneficial for SOP with
respiratory failure. However, corticosteroids should be used in a
short-term to diminish this toxicity.
In conclusion, SPT is effective for SOP with respiratory failure due to
COVID-19. Although the use of systemic corticosteroids is of concern due
to the delay of viral shedding or toxicity, they can be used safely by
selecting optimal cases, timing, and dose. It is necessary to establish
its evidence for further case accumulation and research.