Meduri Protocol - modified for Starship
For patients with severe lung disease who are failing to separate from mechanical ventilation
Ensure the patient does not have an acute active infection (N.B. acute influenza and bacterial sepsis) prior to commencing.
Day 1 - load with 2 mg/kg IV methylprednisolone and commence 6 hours later IV:
Day | 1–14* | 15–21 | 22–28 | 29–30 | 31–32 |
IV methylprednisolone | 0.5 mg/kg Q6H | 0.25 mg/kg | 0.125 mg/kg Q6H | 0.125 mg/kg | 0.125 mg/kg daily |
Enteral† prednisolone | N/A | 1 mg/kg | 0.5 mg/kg | 0.25 mg/kg | 0.125 mg/kg daily |
* Advance to day 15 of the protocol 24 hours after successful extubation if extubated prior to day 15.
† IV is preferable until extubated. Enteral dosing is used once successfully extubated and non-invasive respiratory support is weaning, and feeds are well tolerated.
Have a low threshold for obtaining a non-bronchoscopic clean alveolar lavage specimen and commencing antibiotics during the course of the treatment if clinical suspicions of ventilator associated pneumonia.