Low-dose steroid therapy at an early phase of postoperative acute respiratory distress syndrome.
BACKGROUND
The acute respiratory distress syndrome (ARDS) that develops after thoracic surgery is usually lethal. The use of corticosteroids to treat ARDS has been the subject of great controversy.


METHODS
Therefore we compared conventional therapy with early low-dose steroid therapy in the treatment of postoperative ARDS. Methylprednisolone was given daily as an intravenous push every 6 hours and was changed to a single oral dose or discontinued, with a loading dose of 2 mg/kg followed by 2 mg/kg per day.


RESULTS
Over 2.5 years, 523 major thoracic operations were performed with postoperative ARDS developing in 20 patients (3.8%), of which 8 were treated with conventional therapy and 12 with early low-dose steroid therapy. Early low-dose steroid therapy significantly reduced postoperative mortality, with 7 patients (58.3%) recovering without mechanical ventilation.


CONCLUSIONS
We believe this is the first clinical study of low-dose methylprednisolone at an early phase of postoperative ARDS. The beneficial effects of the use of early low-dose steroids in ARDS are consistent with the hypothesis that fibroproliferation is an early response to lung injury, which is inhibited by early low-dose steroid therapy without disturbing operative wound healing.
Lee
Hyun-Sung
HS
Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea.
Lee
Jong Mog
JM
Kim
Moon Soo
MS
Kim
Hyae Young
HY
Hwangbo
Bin
B
Zo
Jae Ill
JI
D000284:Administration, Oral; D000368:Aged; D004334:Drug Administration Schedule; D004938:Esophageal Neoplasms / Q000601:surgery; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D011182:Postoperative Care; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D015996:Survival Rate; D019616:Thoracic Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016896:Treatment Outcome
D005938:Glucocorticoids; D008775:Methylprednisolone