Effect of Prolonged Methylprednisolone Therapy in Unresolving Acute Respiratory Distress Syndrome
| Autor: | Reba Umberger, Tiffany M. Kelso, Stephanie J. Carson, Stacey Headley, Elizabeth A. Tolley, Umberto G. Meduri, Emmel Golden |
|---|---|
| Rok vydání: | 1998 |
| Předmět: |
Adult
Male medicine.medical_specialty ARDS Multiple Organ Failure Anti-Inflammatory Agents Acute respiratory distress Lung injury Methylprednisolone Severity of Illness Index law.invention Double-Blind Method Randomized controlled trial law Intensive care Fraction of inspired oxygen Humans Medicine Hospital Mortality Prospective Studies Intensive care medicine Cross Infection Respiratory Distress Syndrome Respiratory distress business.industry Respiratory disease General Medicine Middle Aged medicine.disease Survival Analysis Intensive care unit Respiratory Function Tests Intensive Care Units Anesthesia Emergency medicine Female business medicine.drug |
| Zdroj: | JAMA. 280:159 |
| ISSN: | 0098-7484 |
| DOI: | 10.1001/jama.280.2.159 |
| Popis: | Context.—No pharmacological therapeutic protocol has been found effective in modifying the clinical course of acute respiratory distress syndrome (ARDS) and mortality remains greater than 50%.Objective.—To determine the effects of prolonged methylprednisolone therapy on lung function and mortality in patients with unresolving ARDS.Design.—Randomized, double-blind, placebo-controlled trial.Setting.—Medical intensive care units of 4 medical centers.Participants.—Twenty-four patients with severe ARDS who had failed to improve lung injury score (LIS) by the seventh day of respiratory failure.Interventions.—Sixteen patients received methylprednisolone and 8 received placebo. Methylprednisolone dose was initially 2 mg/kg per day and the duration of treatment was 32 days. Four patients whose LIS failed to improve by at least 1 point after 10 days of treatment were blindly crossed over to the alternative treatment.Main Outcome Measures.—Primary outcome measures were improvement in lung function and mortality. Secondary outcome measures were improvement in multiple organ dysfunction syndrome (MODS) and development of nosocomial infections.Results.—Physiological characteristics at the onset of ARDS were similar in both groups. At study entry (day 9 [SD, 3] of ARDS), the 2 groups had similar LIS, ratios of PaO2 to fraction of inspired oxygen (FIO2), and MODS scores. Changes observed by study day 10 for methylprednisolone vs placebo were as follows: reduced LIS (mean [SEM], 1.7 [0.1] vs 3.0 [0.2]; P |
| Databáze: | OpenAIRE |
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