[Evaluation of glucocorticoid in treatment for patients with acute respiratory distress syndrome as a result of serious community-acquired pneumonia].
OBJECTIVE
To evaluate the usage of glucocorticoid (GC) in treatment for patients with acute respiratory distress syndrome (ARDS) resulting from serious community-acquired pneumonia (SCAP).


METHODS
The clinical data from all patients with ARDS resulting from SCAP in medical ICU (MICU) from May 2000 to Feb. 2003 were collected. Their age, sex, acute physiology and chronic health evaluation (APACHE II) score, PaO(2)/FiO(2) and Qs/Qt, the severity of SCAP, mechanical ventilation (MV) and the level of positive end-expiratory pressure (PEEP), time of stay in ICU, improvement of SCAP and oxygenation, as well as mortality and reasons of death were analyzed, respectively. So was did the influence of administration of GC on hypoxemia, septic shock, and their prognosis.


RESULTS
There were 24 cases totally, among them 7 patients had not taken GC, and 5 patients were cured (71.4 percent), and the other 2 cases died (28.6 percent) Their direct cause of death were multiple organ dysfunction syndrome (MODS) and ARDS, respectively In 17 cases GC was given because hypoxemia and septic shock could not be alleviated with ordinary therapy, including MV Among them only 5 patients (29.4 percent) were cured, and all others (12 cases, 70.6 percent) died, and the major direct cause of death was MODS (6 cases, 75.0 percent). A few of them died of ARDS and septic shock (1 case, 12.5 percent, respectively). The severity of SCAP, as well as other clinical data of the survivors, showed no significant difference compared with the nonsurvivors (P>0.05). But except for their PaO2/FiO2, Qs/Qt and shock, their pulmonary infection was better controlled than deaths (P<0.001).


CONCLUSIONS
Refractory hypoxemia and septic shock of patients with pulmonary ARDS might be alleviated by GC when they are treated with routine methods, including MV, thus it enabled to win the time for other effective treatments.
Song
Zhi-fang
ZF
Medical Intensive Care Unit, Xinhua Hospital, The Second Medical University of Shanghai, Shanghai 200092, China.
Guo
Xiao-hong
XH
Wang
Shu-yun
SY
Xie
Wei
W
Yin
Na
N
Zhang
Yue
Y
Shan
Hui-min
HM
Li
Wen-hua
WH
D018806:APACHE; D000328:Adult; D000368:Aged; D017714:Community-Acquired Infections / Q000150:complications*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications*; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000188:drug therapy* / Q000209:etiology
D005938:Glucocorticoids