Practice Pattern of Critical Care Physicians in India for Use of Corticosteroids in COVID-19

Introduction Steroids are recommended as the standard of care in managing severe COVID-19. However, several questions remain unanswered regarding the prescription of steroids which led to differing opinions and practice. We surveyed practice patterns of critical care physicians in India for the use of corticosteroids in COVID-19. Methods This was a nationwide, cross-sectional, online, knowledge attitude practice-based survey, among intensivists for corticosteroid use in COVID-19. The survey questionnaire had seven questions for demographic data and 14 questions in the core survey. Results 384 responses were analyzed from different parts of the country. A majority (81.2%) agreed that steroids improved oxygenation and survival chances. 88.3% agreed that steroids are indicated because of their anti-inflammatory properties, and should be prescribed in patients with moderate (75.8%), severe (59.9%), or critical (41.1%) COVID-19. 68.8% of physicians start steroids on the basis of “need for oxygen therapy” and hyperglycemia (85.2%) was the most commonly reported complication. 59.1% prefer prescribing methylprednisolone followed by Dexamethasone (38.8%). 51.8% preferred to use low dose steroids, and 59.1% have used “pulse steroids’’. Rather than a fixed duration of therapy, 66.9% of the respondents rely on “clinical improvement” before stopping steroids, even if it meant continuing steroids for prolonged periods beyond 14 days (34.1%). 57.8% always taper steroids before stopping. Conclusions We found wide variation in the practice patterns of critical care physicians in India for use of Corticosteroids in COVID-19. The dilemma regarding when to initiate, type of steroid, dose, and duration of therapy still persist emphasizing the need for further research.