Tuberc Respir Dis.  2003 Apr;54(4):429-438.

The Changes of Physiologic Parameters with Time in Steroid treated-Late Acute Respiratory Distress Syndrome Patients

• Jeon IS
• Suh GY
• Koh WJ
• Pyun YJ
• Kang EH
• Ham HS
• Oui M
• Chung MP
• Kim H
• Kwon OJ

Abstract

BACKGROUND: The mortality from acute respiratory distress syndrome(ARDS) is > 40-50%. Although some prospective trials have failed to demonstrate a survival benefit of steroids in the early stages of ARDS, there are some reports showing some success with steroids in the later stages. This study observed the changes in the physiologic parameters with time in late ARDS patients who were treated with steroids.
METHODS
The medical charts of 28 intensive care unit patients(male:female=24:4; mean age 64 years), who had been diagnosed with refractory late ARDS (PaO2/FIO2 < 200) and were treated with corticosteroids from December 1999 to July 2002, were retrospectively reviewed. The patients were divided into two groups: the weaned group(n=14), which included the patients who had been successfully weaned from a ventilator after corticosteroid therapy, and the failed group(n=14), which included the patients who had failed weaning. The physiologic parameters included the PaO2/FIO2 ratio, the positive end-expiratory pressure(PEEP) level, the PaCO2, compliance, the sequential organ failure assessment(SOFA) score, the acute physiologic and the chronic health evaluation(APACHE) II score, and the Murray Lung Injury Score(LIS) in the two groups were compared from the day of mechanical ventilation(Dmv) to 7 days after the corticosteroid therapy.
RESULTS
There was no significant difference in the clinical characteristics and the physiologic parameters between the two groups prior to the corticosteroid therapy except for the SOFA score at Dmv(weaned group : 6.6+/-2.5 vs failed group : 8.8+/-2.9, p=0.047) . However, within 7 days after corticosteroid therapy, there was significant improvement in the PaO2/FIO2 ratio, the PEEP level, the PaCO2, the SOFA score, the APACHE II score, and the LIS of the weaned group compared to the failed group.
CONCLUSIONS
During corticosteroid therapy in late ARDS, the continuation of corticosteroid therapy should be determined carefully in patients who do not show improvement in their physiologic parameters by day 7.

Keyword

Respiratory distress syndrome; Intensive Care Units; Glucocorticoids; Methylprednisolone; Multiple Organ Failure

MeSH Terms

Adrenal Cortex Hormones
APACHE
Compliance
Glucocorticoids
Humans
Intensive Care Units
Lung Injury
Methylprednisolone
Mortality
Multiple Organ Failure
Respiratory Distress Syndrome, Adult*
Retrospective Studies
Steroids
Ventilators, Mechanical
Weaning
Adrenal Cortex Hormones
Glucocorticoids
Methylprednisolone
Steroids