Anest. intenziv. Med. 2008;19(6):314-318

Corticosteroids in the treatment of ALI/ARDSAnaesthesiology - Review articles

Raděj Jaroslav*, Kroužecký Aleš, Sýkora Roman, Chvojka Jiří, Karvunidis Thomas, Novák Ivan, Matějovič Martin
I. interní klinika - JIP, Univerzita Karlova v Praze, Lékařská fakulta v Plzni, Fakultní nemocnice Plzeň

ALI/ARDS stems from the inflammatory response to a severe pulmonary or extrapulmonary injury. An intervention in the pro-inflammatory imbalance seems to be a logical life-saving step in addition to the general principles of ARDS management. The biomolecular background of corticosteroid treatment of patients with ARDS could be the cytoplasmatic glucocorticoid receptor-α. Very few prospective randomised or observatory studies have been performed to date. The results of several initial studies of high-dose short-term methylprednisolone administration did not confirm any benefit of the treatment, actually the mortality was higher in the treatment group. The Meduri study of long-term administration of low-dose methylprednisolone to patients with persistent ARDS found a significant decrease of both organ dysfunction and mortality in a very small group of 24 patients. A national US study supported by The National Heart, Lung, and Blood Institute ARDS Clinical Trials Network did not confirm a decrease of 60-day and 180-day mortality in 180 patients with persistent ARDS who had been treated by low-dose corticosteroids for more than three weeks. An improvement of the lung function and haemodynamics was seen. Increased mortality was evident in the group of patients commenced on steroid therapy after 14 days of ARDS duration. Two small questionable studies followed. The meta-analysis of all these studies is controversial. The performed studies' protocols are very heterogenic and do not provide a clear recommendation for steroid treatment. These studies due to their failure to demonstrate a mortality benefit or their design do not allow us to recommend the routine use of corticosteroid treatment in patients with ARDS.

Keywords: acute lung injury (ALI); acute respiratory distress syndrome (ARDS); corticosteroids; mortality

Received: May 19, 2008; Accepted: September 21, 2008; Published: December 1, 2008  Show citation

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Raděj J, Kroužecký A, Sýkora R, Chvojka J, Karvunidis T, Novák I, Matějovič M. Corticosteroids in the treatment of ALI/ARDS. Anest. intenziv. Med. 2008;19(6):314-318.
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    References

    1. Bernard, G. R., Artigas, A., Brigham, K. L., Carlet, J., Falke, K. et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am. J. Respir. Crit. Care Med., 1994, 149, p. 818-824. Go to original source... Go to PubMed...
    2. Agarwal, R., Srinivas, R., Nath, A., Jindal, S. K. Is the mortality higher in the Pulmonary versus the Extrapulmonary ARDS? A meta-analysis. Chest, 2007, p. 7.
    3. Blennerhassett, J. B. Shock lung and diffuse alveolar damage pathological and pathogenetic considerations. Pathology, 1985, 17, p. 239-247. Go to original source... Go to PubMed...
    4. Idell, S. Coagulation, fibrinolysis, and fibrin deposition in acute lung injury. Crit. Care Med., 2003, 31, p. 213-220. Go to original source... Go to PubMed...
    5. Lang, J. D., McArdle, P. J., O'Reilly, P. J., Matalon, S. Oxidant-antioxidant balance in acute lung injury. Chest, 2002, 122, p. 314-320. Go to original source... Go to PubMed...
    6. Tasaka, S., Amaya, F., Hashimoto, S., Ishizaka, A. Roles of oxidants and redox signaling in the pathogenesis of acute respiratory distress syndrome. Antioxid. Redox. Signal, 2008, 10, p. 739-753. Go to original source... Go to PubMed...
    7. Wind, J., Versteegt, J., Twisk, J., van der Werf, T. S., Bindels, A. J. et al. Epidemiology of acute lung injury and acute respiratory distress syndrome in The Netherlands: a survey. Respir. Med., 2007, 101, p. 2091-2098. Go to original source... Go to PubMed...
    8. Rubenfeld, G. D., Caldwell, E., Peabody, E., Weaver, J., Martin, D. P. et al. Incidence and outcomes of acute lung injury. N. Engl. J. Med., 2005, 20, p. 1685-1693. Go to original source... Go to PubMed...
    9. Meduri, G. U., Muthiah, M. P., Carratu, P., Eltorky, M., Chrousos, G. P. Nuclear factor-kappaB- and glucocorticoid receptor alpha-mediated mechanisms in the regulation of systemic and pulmonary inflammation during sepsis and acute respiratory distress syndrome. Evidence for inflammation-induced target tissue resistance to glucocorticoids. Neuroimmunomodulation, 2005, 12, p. 321-338. Go to original source... Go to PubMed...
    10. Bernard, G. R., Luce, J. M., Sprung, C. L., Rinaldo, J. E., Tate, R. M. et al. High-dose corticosteroids in patients with the adult respiratory distress syndrome. N. Engl. J. Med., 1987, 17, p. 1565-1570. Go to original source... Go to PubMed...
    11. Steinberg, K. P., Hudson, L. D., Goodman, R. B., Hough, C. L., Lanken, P. N. et al. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N. Engl. J. Med., 2006, 20, p. 1671-1678. Go to original source...
    12. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N. Engl. J. Med., 2000, 4, p. 1301-1308.
    13. Bersten, A. D., Edibam, C., Hunt, T. et al. Incidence and mortality of acute lung injury and the acute respiratory distress syndrome in three Australian states. Am. J. Respir. Crit. Care Med., 2002, 165, p. 443-448. Go to original source... Go to PubMed...
    14. Meade, M. O., Cook, D. J., Guyatt, G. H., Slutsky, A. S., Arabi, Y. M. et al. (Lung Open Ventilation Study Investigators) Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA, 2008, 13, p. 637-645. Go to original source... Go to PubMed...
    15. Ranieri, V. M., Suter, P. M., Tortorella, C., De Tullio, R., Dayer, J. M. et al. Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial. JAMA, 1999, 7, p. 54-61. Go to original source... Go to PubMed...
    16. Mancebo, J., Fernandez, R., Blanch, L., Rialp, G., Gordo, F., Ferrer, M. et al. A multicenter trial of prolonged prone ventilation in severe acute respiratory distress syndrome. Am. J. Respir. Crit. Care Med., 2006, 173, p. 1233-1239. Go to original source... Go to PubMed...
    17. Cordell-Smith, J. A., Roberts, N., Peek, G. J., Firmin, R. K. Traumatic lung injury treated by extracorporeal membrane oxygenation (ECMO). Injury, 2006, 37, p. 29-32. Go to original source... Go to PubMed...
    18. Hemmila, M. R., Rowe, S. A., Boules, T. N., Miskulin, J., McGillicuddy, J. W. et al. Extracorporeal life support for severe acute respiratory distress syndrome in adults. Ann. Surg., 2004, 240, p. 595-605. Go to original source... Go to PubMed...
    19. Wiedemann, H. P., Wheeler, A. P., Bernard, G. R., Thompson, B. T., Hayden, D. et al. (National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network) Comparison of two fluid-management strategies in acute lung injury. N. Engl. J. Med., 2006, 15, p. 2564-2575.
    20. Rhen, T., Cidlowski, J. A. Antiinflammatory action of glucocorticoids - new mechanisms for old drugs. N. Engl. J. Med., 2005, 20, p. 1711-1723. Go to original source... Go to PubMed...
    21. Barnes, P. J. Corticosteroid effects on cell signalling. Eur. Respir. J., 2006, 27, p. 413-426. Go to original source... Go to PubMed...
    22. Ognibene, F. P., Martin, S. E., Parker, M. M., Schlesinger, T., Roach, P. et al. Adult respiratory distress syndrome in patients with severe neutropenia. N. Engl. J. Med., 1986, 28, p. 547-551. Go to original source... Go to PubMed...
    23. Dellinger, R. P., Levy, M. M., Carlet, J. M., Bion, J., Parker, M. M. et al. for the International Surviving Sepsis Campaign Guidelines Committee Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Crit. Care Med., 2008, 36, p. 296-327. Go to original source... Go to PubMed...
    24. Atkins, D., Best, D., Briss, P. A., Eccles, M., Falck-Ytter, Y., Flottorp, S. et al. GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ, 2004, 19, p. 490.
    25. Luce, J. M., Montgomery, A. B., Marks, J. D., Turner, J., Metz, C. A. et al. Ineffectiveness of high-dose methylprednisolone in preventing parenchymal lung injury and improving mortality in patients with septic shock. Am. Rev. Respir. Dis., 1988, 138, p. 62-68. Go to original source... Go to PubMed...
    26. Weigelt, J. A., Norcross, J. F., Borman, K. R., Snyder, W. H. Early steroid therapy for respiratory failure. Arch. Surg., 1985, 120, p. 536-540. Go to original source... Go to PubMed...
    27. Bernard, G. R., Luce, J. M., Sprung, C. L., Rinaldo, J. E., Tate, R. M. et al. High-dose corticosteroids in patients with the adult respiratory distress syndrome. N. Engl. J. Med., 1987, 317, p. 1565-1570. Go to original source... Go to PubMed...
    28. Bone, R. C., Fisher, C. J. Jr, Clemmer, T. P., Slotman, G. J., Metz, C. A. Early methylprednisolone treatment for septic syndrome and the adult respiratory distress syndrome. Chest, 1987, 92, p. 1032-1036. Go to original source... Go to PubMed...
    29. Meduri, G. U., Headley, S., Golden, E., Carson, S., Umberger, R., Kelso, T., Tolley, E. Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome. A randomized controlled trial. JAMA, 1988, 280, p. 159-165. Go to original source... Go to PubMed...
    30. Annane, D., Sebille, V., Bellissant, E. Effect of low doses of corticosteroids in septic shock patients with or without early acute respiratory distress syndrome. Crit. Care Med., 2006, 34, p. 22-30. Go to original source... Go to PubMed...
    31. Meduri, G. U., Golden, E., Freire, A. X., Taylor, E., Zaman, M. et al. Methylprednisolone infusion in early severe ARDS: results of a randomized controlled trial. Chest, 2007, 131, p. 954-963. Go to original source... Go to PubMed...
    32. Meduri, G. U., Marik, P. E., Chrousos, G. P., Pastores, S. M., Arlt, W. et al. Steroid treatment in ARDS: a critical appraisal of the ARDS network trial and the recent literature. Intensive Care Med., 2008, 34, p. 61-69. Go to original source... Go to PubMed...
    33. Confalonieri, M., Urbino, R., Potena, A., Piattella, M., Parigi, P. et al. Hydrocortisone infusion for severe community-acquired pneumonia: a preliminary randomized study. Am. J. Respir. Crit. Care Med., 2005, 1, p. 242-248. Go to original source... Go to PubMed...
    34. Papazian, L., Doddoli, C., Chetaille, B., Gernez, Y., Thirion, X. et al. A contributive result of open-lung biopsy Improves survival in acute respiratory distress syndrome patients. Crit. Care Med., 2007, 35, p. 755-762. Go to original source... Go to PubMed...
    35. Annane, D., Sébille, V., Charpentier, C., Bollaert, P. E., François, B. et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA, 2002, 21, p. 862-871. Go to original source... Go to PubMed...
    36. Sprung, C. L., Annane, D., Keh, D., Moreno, R., Singer, M. et al. CORTICUS Study Group. Hydrocortisone therapy for patients with septic shock. N. Engl. J. Med., 2008, 10, p. 111-124. Go to original source... Go to PubMed...
    37. Marik, P. E., Pastores, S. M., Annane, D., Meduri, G. U., Sprung, C. L. et al. American College of Critical Care Medicine. Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine. Crit. Care Med., 2008, 36, p. 1937-1949. Go to original source... Go to PubMed...

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