Korean J Crit Care Med.  2009 Aug;24(2):80-86. 10.4266/kjccm.2009.24.2.80.

A Preliminary Study on the Effect of "Low-dose" Glucocorticoid Therapy for Patients with Persistent Acute Respiratory Distress Syndrome

• Nam HS
• Park MR
• Park SY
• Lim SY
• Kim SA
• Song JU
• Jeon K
• Kim H
• Kwon OJ
• Suh GY

• KMID: 2228351
• DOI: http://doi.org/10.4266/kjccm.2009.24.2.80

Abstract

BACKGROUND
The role of glucocorticoids for treating persistent acute respiratory distress syndrome (ARDS) is matter of debate. In the previous studies, the side effects of moderate doses of glucocorticoids might have negated positive effects of glucocorticoids. This study aimed at determining the feasibility of administering "low-dose" glucocorticoid to treat the patients who suffer with persistent ARDS.
METHODS
We retrospectively reviewed the medical records of twelve patients with ARDS of at least seven days' duration and who were treated with "low-dose" glucocorticoid (starting dose of 1 mg/kg) between June 2007 to December 2008. The patients were divided by whether or not they were successfully weaned from the ventilator after glucocorticoid therapy. The baseline characteristics and physiologic parameters were recorded for up to 7 days after starting glucocorticoid therapy.
RESULTS
Five patients (42%) were included in the weaned group. There was no significant difference in the clinical characteristics and the physiologic parameters between the two groups on the day of ARDS. Yet the weaned group had a significantly lower Sequential Organ Failure Assessment (SOFA) score, as compared to that of the failed group [3 (3-6) vs 8 (5-12), p = 0.009)] at start of glucocorticoid treatment. After 3 days of glucocorticoid therapy, there was significant improvement in the PEEP, the PaO2/FIO2 ratio, the PCO2, the SOFA score and the Murray Lung Injury Score of the weaned group, as compared to that of the failed group. There were no major neuromuscular side effects from the therapy.
CONCLUSIONS
This study suggests that the "low-dose" glucocorticoid therapy is feasible and that the SOFA score and the physiologic parameters may assist in determining whether or not to initiate and to continue glucocorticoid therapy for the patients who are suffering with persistent ARDS.

Keyword

acute respiratory distress syndrome; "low-dose" glucocorticoid; physiologic parameters; sequential organ failure assessement

MeSH Terms

Glucocorticoids
Humans
Lung Injury
Medical Records
Respiratory Distress Syndrome, Adult
Retrospective Studies
Stress, Psychological
Ventilators, Mechanical
Glucocorticoids