[A case of ARDS after esophagectomy treated with low-dose steroid therapy].
A 48-year-old woman was found to have an esophageal cancer, and after preoperative chemotherapy with cisplatin (CDDP)/5-fluorouracil (5-FU), radical subtotal esophagectomy was performed. On the fifth day after surgery, her respiratory condition suddenly worsened and a chest radiograph showed low permeability in both lung fields, leading to a diagnosis of acute respiratory distress syndrome (ARDS) and intubation for mechanical ventilation. Since clinical examination did not detect signs of infection on the seventh day, we began administering hydrocortisone at a dose of 300 mg. Her inflammatory response and respiratory condition improved by the next day and the dose of hydrocortisone was gradually reduced. The patient was extubated on the 13th day, administration of steroids was halted on the 22nd day, and she was discharged from the hospital on the 26th day. ARDS remains a refractory disease and no drug has proven to be effective in randomized controlled trials. The use of steroids for ARDS management remains controversial. Our present case suggests that low-dose steroids from an early stage in uninfected ARDS patients may improve prognosis.
Dept. of Surgery, Division of Digestive Surgery, Kyoto Prefectural University of Medicine.
Shoichiro
S
Hikami
Atsushi
A
Shiozaki
Hitoshi
H
Fujiwara
Hirotaka
H
Konishi
Ryo
R
Morimura
Yasutoshi
Y
Murayama
Shuhei
S
Komatsu
Yoshiaki
Y
Kuriu
Hisashi
H
Ikoma
Takeshi
T
Kubota
Masayoshi
M
Nakanishi
Akio
A
Kimura
Daisuke
D
Ichikawa
Kazuma
K
Okamoto
Chouhei
C
Sakakura
Eigo
E
Otsuji
D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D013256:Steroids / Q000627:therapeutic use*
D013256:Steroids