What management should be initiated in ICU?
- Standard supportive ICU care, lung protective ventilation with tidal volumes of 6-8ml/kg
- Antibiotics with early initiation of steroids if vasculitis suspected cause and to cover for possible infectious cause; antibiotics can be discontinued within 24-48 hours, based on cultures and procalcitonin
- Steroid treatment should be guided by MDT for suspected vasculitis. Treatment regimes often consist of pulsed methylprednisolone (e.g 125-250 mg IV QDS for three days followed by 1mg/kg for maintenance)
- Other treatment options for antibody-mediated diseases include plasma exchange therapy and other immunosuppressive agents such as cyclophosphamide