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.