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Corticosteroids in the treatment of ALI/ARDS


Authors: Raděj Jaroslav;  Kroužecký Aleš;  Sýkora Roman;  Chvojka Jiří;  Karvunidis Thomas;  Novák Ivan;  Matějovič Martin
Authors place of work: I. interní klinika – JIP, Univerzita Karlova v Praze, Lékařská fakulta v Plzni, Fakultní nemocnice Plzeň
Published in the journal: Anest. intenziv. Med., 19, 2008, č. 6, s. 314-318
Category: Anaesthesiology - Review Article

Summary

ALI/ARDS stems from the inflammatory response to a severe pulmonary or extrapulmonary injury. An intervention in the pro-inflammatory imbalance seems to be a logical life-saving step in addition to the general principles of ARDS management. The biomolecular background of corticosteroid treatment of patients with ARDS could be the cytoplasmatic glucocorticoid receptor-α. Very few prospective randomised or observatory studies have been performed to date. The results of several initial studies of high-dose short-term methylprednisolone administration did not confirm any benefit of the treatment, actually the mortality was higher in the treatment group. The Meduri study of long-term administration of low-dose methylprednisolone to patients with persistent ARDS found a significant decrease of both organ dysfunction and mortality in a very small group of 24 patients. A national US study supported by The National Heart, Lung, and Blood Institute ARDS Clinical Trials Network did not confirm a decrease of 60-day and 180-day mortality in 180 patients with persistent ARDS who had been treated by low-dose corticosteroids for more than three weeks. An improvement of the lung function and haemodynamics was seen. Increased mortality was evident in the group of patients commenced on steroid therapy after 14 days of ARDS duration. Two small questionable studies followed. The meta-analysis of all these studies is controversial. The performed studies’ protocols are very heterogenic and do not provide a clear recommendation for steroid treatment. These studies due to their failure to demonstrate a mortality benefit or their design do not allow us to recommend the routine use of corticosteroid treatment in patients with ARDS.

Key words:
acute lung injury (ALI) – acute respiratory distress syndrome (ARDS) – corticosteroids – mortality


Zdroje

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Štítky
Anaesthesiology, Resuscitation and Inten Intensive Care Medicine
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