Early vs Late Methylprednisolone in Acute Respiratory Distress Syndrome.

Abstract

Acute respiratory distress syndrome (ARDS) is the clinical manifestation of severe acute lung injury. It is characterized by dyspnea, profound hypoxemia, diffuse bilateral infiltrates secondary to noncardiogenic pulmonary edema on chest radiography, and decreased lung compliance. It occurs most frequently in the setting of sepsis, aspiration of gastric contents, trauma, or multiple transfusions (Kahdi et al., 2003). ARDS places a significant burden on the healthcare system, with an estimated prevalence of 7% of ICU admissions and hospital mortality rate of 50% (Brun et al., 2004). Provision of supplemental oxygen, lung rest, and supportive care are the fundamentals of therapy. Acute respiratory distress syndrome frequently requires endotracheal intubation and mechanical ventilation. A low tidal volume and low plateau pressure ventilator strategy is recommended to avoid ventilator-induced injury (Kahdi et al., 2003). The use of low-dose corticosteroids was associated with improved mortality and morbidity outcomes without increased adverse reactions (Benjamin et al., 2009). The present study was designed to evaluate and compare the role of methylprednisolone in improvement of PaO2/FiO2 ratio, lung injury score, and reduction in C-reactive protein (CRP) in early and late phases of ARDS. The present study consisted of 90 patients divided alternatively by 1:1 manner into two groups: group A consisted of 45 patients with early phase of ARDS (≤ 3 days) who received methylprednisolone protocol since diagnosis plus conventional management for ARDS, compared to group B which consisted of 45 patients with late phase of ARDS (7-14 days) who received conventional management for ARDS alone, Then methylprednisolone protocol added after day 7 of diagnosis. All patients aged between 18 and 55 years, without Uncontrolled DM, Uncontrolled Hypertension, cardiac problems (HF, IHD, Valvular lesions or Cardiomyopathy), previous history of pulmonary disease, hepatic or renal Failure, prior corticosteroid treatment, pregnancy, upper GI bleeding, extensive burn nor terminal illness. Follow up hemodynamics, MAP, ABG, Na+, K+, RBS, CRP, CXR, Ventilator parameters ( FiO2, tidal volume, RR, PEEP and Pressures), infection survey and GIT bleeding. The present study showed that Methylprednisolone was effective in both early and late phases of ARDS with improvement in oxygenation (PaO2/FIO2 ratio), PEEP, CXR and LIS started at day 4 and reduction of CRP at day 5. But with superior and statistically more significant results (like reduction in LIS ≥1 and successful extubation by day 7) in early ARDS when compared with Late ARDS. As regard, complications there was no statistically significant differences in MAP, RBS, serum sodium, serum potassium, GI bleeding nor new infection.