Improved Oxygenation by Steroid Pulse Therapy in Early-Phase Acute Respiratory Distress Syndrome

• Sumi Yuka

  Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine

• Ogura Hiroshi

  Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine

• Akashi Kouji

  Saiseikai Senri Hospital Senri Critical Care Medical Center

• Tohma Yoshiki

  Nakakawachi Medical Center of Acute Medicine

• Tabuse Hisayuki

  Nakakawachi Medical Center of Acute Medicine

• Mizushima Yasuaki

  Senshu Critical Care Medical Center

• Yokota Junichirou

  Sakai Municipal Hospital

• Sugimoto Hisashi

  Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine

• Fujii Chiiho

  Asahikawasou Minamiehime Hospital

抄録

Objective and Background: Although short-duration, high-dose glucocorticoid therapy is reportedly ineffective for early-phase acute respiratory distress syndrome (ARDS), steroid pulse therapy is often used in Japan for life-threatening cases because of its beneficial effects on oxygenation. Thus, we evaluated the effect of steroid pulse therapy on oxygenation for early-phase ARDS. Method: Cases of early-phase ARDS treated with steroid pulse therapy in intensive care units of four critical care medical centers in Japan from 2000 to 2003 were investigated. Clinical course and serial changes in PaO₂/F_IO₂ ratio were evaluated. Results: Twenty-nine patients received methylprednisolone 1 g/day for 3 days; 20 patients subsequently received prolonged methylprednisolone treatment. Causes of ARDS were pneumonia (n=23), extrapulmonary sepsis (n=4) and other factors (n=2). The overall mortality rate was 24.1%. PaO₂/F_IO₂ ratios improved significantly after initiation of steroid pulse therapy, in comparison to pretreatment values (day 0: 119.8 ± 30.6, day 1: 172.1 ± 63.7^*, day 2: 196.4 ± 90.0^*, day 3: 218.4 ± 92.0^*, mean ± SD, ^*p < 0.05 vs. day 0). Significant improvement in oxygenation was observed in both survivors and non-survivors, but the PaO₂/F_IO₂ ratio in non-survivors subsequently deteriorated. In seven patients with life-threatening hypoxemia (PaO₂/F_IO₂ ratio < 100 at day 0), oxygenation improved significantly after pulse treatment; five of these patients survived. Conclusions: Three day steroid pulse therapy can improve oxygenation in patients with progressive ARDS even in the early phase. Steroid therapy for early-phase ARDS should be reconsidered.

収録刊行物

• 日本救急医学会雑誌

  日本救急医学会雑誌 18 (1), 1-9, 2007

  一般社団法人 日本救急医学会

キーワード

• ARDS
• steroid pulse therapy
• oxygenation

詳細情報

• CRID: 1390282679346009600
• NII論文ID: 130004542115
• NII論文ID: 10018881487
• NII書誌ID: AN10284604
• DOI: 10.3893/jjaam.18.1
• ISSN: 18833772
• ISSN: 0915924X
• Web Site: https://search.jamas.or.jp/link/ui/2007193547
• 本文言語コード: en
• データソース種別:
  • JaLC
  • Crossref
  • CiNii Articles
• 抄録ライセンスフラグ: 使用不可