title: Surviving severe acute respiratory distress syndrome: utility of open-lung biopsy and large doses of dexamethasone.
abstract: The etiology of acute respiratory distress syndrome is wide and mortality is extremely high. We describe a patient dying from severe acute respiratory distress syndrome who had a tremendous recovery after receiving dexamethasone (1 g daily). This patient required positive end-expiratory pressure (up to 18 mm/Hg) and fractional inspiratory oxygen (up to 100%). Thirty-six hours after the large dose of corticosteroids, the respiratory mechanics and oxygenation were acceptable for extubation. Acute respiratory distress syndrome was proven and other etiologies of respiratory failure were ruled out by a bedside open-lung biopsy. The biopsy proven acute respiratory distress syndrome dramatically resolved with this salvage therapy. High-dose usage of corticosteroids for acute respiratory distress syndrome has tremendous potential.
authors.affiliation: Division of Critical Care, Department of Medicine, Montefiore Medical Center for the Albert Einstein College of Medicine, Bronx, New York, USA. deshpandek@aol.com
authors.forename: Kedar S
authors.initials: KS
authors.lastname: Deshpande
authors.forename: David W
authors.initials: DW
authors.lastname: Appel
authors.forename: Margarita T
authors.initials: MT
authors.lastname: Camacho
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Tanaka
authors.forename: Vladimir
authors.initials: V
authors.lastname: Kvetan
mesh_terms: D000328:Adult; D001706:Biopsy; D003907:Dexamethasone / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D008168:Lung / Q000473:pathology*; D008775:Methylprednisolone / Q000008:administration & dosage; D012074:Remission Induction; D045169:Severe Acute Respiratory Syndrome / Q000188:drug therapy* / Q000473:pathology*
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; D008775:Methylprednisolone