The Role of Inhaled Corticosteroids and B2 Agonist in Prevention of ARDS in High Risk Patients Admitted to ICU

Abstract

Abstract Background: Acute respiratory distress syndrome (ARDS) is a life threatening respiratory failure due to lung injury from a variety of precipitants. Pathologically ARDS is characterised by diffuse alveolar damage, alveolar capillary leakage, and protein rich pulmonary oedema leading to the clinical manifestation of poor lung compliance, severe hypoxaemia, and bilateral infiltrates on chest radiograph. Objective: The aim of this study is to evaluate the effect of inhaled corticosteroids and B2 agonist in decreasing the incidence of ARDS in high risk patients admitted to ICU. Methodology: This prospective study included 100 cases admitted to Ain Shams University hospitals for variable medical problems, and were at risk of ARDS development. There were four drug groups studied in this study according to their role in progression and prevention of ARDS in those hospitalized patients. These drug groups were group C (4ml saline), group S (salbutamol), group F (budesonide), and group M (budesonide and salbutamol). Results: ARDS was less likely to develop with the use of salbutamol only or combined with budesonide inhalation in groups S and M respectively. The primary outcome was development of ARDS. The secondary outcome was mechanical ventilation and prolonged ICU stay. Six cases (24%) in each of group C and F developed ARDS, mechanical ventilation and prolonged ICU stay. Just two cases (8%) in each of groups S and M developed ARDS, mechanical ventilation and prolonged ICU stay. The difference between the 4 groups in the incidence of ARDS development was not so far, but it was clearly evident. Conclusion: The use of inhaled beta 2 agonists was associated with decreased risk of ARDS, mechanical ventilation and prolonged ICU stay when adjusted for baseline characteristics, predisposing conditions and severity of illness.