Methylprednisolone Infusion in Early Severe ARDS
| Autor: | Mary Gibson, G. Umberto Meduri, Muhammad K. Zaman, Reba Umberger, Amado X. Freire, Stephanie J. Carson, Edwin Taylor, Emmel Golden |
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| Rok vydání: | 2007 |
| Předmět: |
Pulmonary and Respiratory Medicine
Artificial ventilation Mechanical ventilation ARDS business.industry medicine.medical_treatment Organ dysfunction Lung injury Critical Care and Intensive Care Medicine medicine.disease Methylprednisolone Fraction of inspired oxygen Anesthesia medicine medicine.symptom Cardiology and Cardiovascular Medicine Multiple organ dysfunction syndrome business medicine.drug |
| Zdroj: | Chest. 131:954-963 |
| ISSN: | 0012-3692 |
| DOI: | 10.1378/chest.06-2100 |
| Popis: | Objective To determine the effects of low-dose prolonged methylprednisolone infusion on lung function in patients with early severe ARDS. Design Randomized, double-blind, placebo-controlled trial. Setting ICUs of five hospitals in Memphis. Participants Ninety-one patients with severe early ARDS (≤ 72 h), 66% with sepsis. Interventions Patients were randomized (2:1 fashion) to methylprednisolone infusion (1 mg/kg/d) vs placebo. The duration of treatment was up to 28 days. Infection surveillance and avoidance of paralysis were integral components of the protocol. Main outcome measure The predefined primary end point was a 1-point reduction in lung injury score (LIS) or successful extubation by day 7. Results In intention-to-treat analysis, the response of the two groups (63 treated and 28 control) clearly diverged by day 7, with twice the proportion of treated patients achieving a 1-point reduction in LIS (69.8% vs 35.7%; p=0.002) and breathing without assistance (53.9% vs 25.0%; p=0.01). Treated patients had significant reduction in C-reactive protein levels, and by day 7 had lower LIS and multiple organ dysfunction syndrome scores. Treatment was associated with a reduction in the duration of mechanical ventilation (p = 0.002), ICU stay (p = 0.007), and ICU mortality (20.6% vs 42.9%; p=0.03). Treated patients had a lower rate of infections (p = 0.0002), and infection surveillance identified 56% of nosocomial infections in patients without fever. Conclusions Methylprednisolone-induced down-regulation of systemic inflammation was associated with significant improvement in pulmonary and extrapulmonary organ dysfunction and reduction in duration of mechanical ventilation and ICU length of stay. |
| Databáze: | OpenAIRE |
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