Late steroid therapy in primary acute lung injury.
OBJECTIVE
To investigate the effect of steroid treatment in the late phase of primary acute lung injury (ALI) with special emphasis on pneumococcal pneumonia.


METHODS
Retrospective study.


METHODS
Multidisciplinary intensive care unit (ICU) in a university hospital.


METHODS
Of 31 patients with primary ALI requiring mechanical ventilation for more than 10 days, 16 were treated with methylprednisolone and 15 served as controls.


RESULTS
Steroid and control groups were comparable regarding demographic data, APACHE II score, Multiple Organ Dysfunction Score (MODS), and PaO2/FiO2-ratio on admission to ICU. The mean start of steroid therapy was 9.7 days after establishment of respiratory failure, and values for control patients were registered on day 10. The PaO2/FiO2 ratio improved significantly within 3 days after the start of steroid therapy, and MODS and C-reactive protein decreased concurrently. No differences in mortality, in length of ICU stay, or in length of mechanical ventilation were detectable. In a subgroup analysis, for patients with Streptococcus pneumoniae pneumonia, beneficial change in physiological variables was evident.


CONCLUSIONS
In patients with primary ALI, steroid therapy, started 10 days after the start of mechanical ventilation, improves gas exchange and is associated with a decrease in multiorgan dysfunction.
Varpula
T
T
Department of Anesthesiology, Helsinki University Central Hospital, Finland. tero.varpula@huch.fi
Pettilä
V
V
Rintala
E
E
Takkunen
O
O
Valtonen
V
V
D018806:APACHE; D000208:Acute Disease; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D011008:Pneumococcal Infections / Q000145:classification / Q000188:drug therapy* / Q000628:therapy; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000145:classification / Q000188:drug therapy* / Q000628:therapy; D012189:Retrospective Studies
D005938:Glucocorticoids; D008775:Methylprednisolone