Abstract
BackgroundAcute stroke patients suffering from aspiration may present with acute respiratory distress syndrome (ARDS). There is still a lack of convincing data about the efficacy of corticosteroids in the treatment of aspiration-related ARDS. Therefore, we evaluated the clinical impact of corticosteroids on aspiration-related ARDS.MethodsBetween 2012 and 2014, we conducted a retrospective study among acute stroke patients diagnosed with aspiration-related ARDS. The data analyzed included demographic characteristics, clinical manifestations, laboratory examinations, chest imaging, and hospital discharge status.ResultsSeventy-three acute stroke patients were diagnosed with aspiration-related ARDS. The hospital mortality rate was 39.7 %. Corticosteroids were administered in 47 patients (64.4 %). The mean dosage was 1.14 (standard deviation [SD] 0.47) mg/kg daily of methylprednisolone (or an equivalent) by intravenous infusion for a period of 7.3 (SD 3.8) days. Ground glass opacities in chest computed tomography images were resolved when corticosteroids were administered. The admission National Institute of Health Stroke Scale score (odds ratio [OR] 5.17, 95 % confidence interval [CI] 1.27–10.64) and Acute Physiology and Chronic Health Evaluation II score (OR 2.00, 95 % CI 1.12–3.56) were associated with an increased risk of hospital mortality, while albumin (OR 0.81, 95 % CI 0.64–0.92) and corticosteroids therapy (OR 0.50, 95 % CI 0.35–0.70) were associated with a decreased risk.ConclusionsLow-dose and short-term corticosteroid therapy may have an impact on survival in aspiration-related ARDS. The presence of ground glass opacities on the chest computed tomography, performed to rule out aspiration-related ARDS, could be translated into an increased possibility of positive response to corticosteroid therapy.
Highlights
Acute stroke patients suffering from aspiration may present with acute respiratory distress syndrome (ARDS)
All acute stroke patients had to meet all of the following criteria [13, 14]: (1) aged 18 years or older; (2) diagnosed with rapidly developed clinical signs of cerebral function disturbance of vascular origin, and classified based on results from the first brain scan into cerebral infarct, intracerebral hemorrhage, and subarachnoid hemorrhage, according to the World Health Organization definition; (3) presented within 24 h of the onset of acute stroke; (4) confirmed by head computerized tomography (CT) or brain magnetic resonance imaging (MRI)
Patient population Of the 2286 acute stroke patients enrolled in the study, 551 patients were diagnosed with aspiration pneumonia
Summary
Acute stroke patients suffering from aspiration may present with acute respiratory distress syndrome (ARDS). We evaluated the clinical impact of corticosteroids on aspiration-related ARDS. ARDS caused by aspiration is a major cause of death. The early diagnosis of aspiration-related ARDS is crucial to improve patient outcomes, as well as to choose the optimal treatment, including mechanical ventilation. Because dysregulated inflammation is the cardinal feature of ARDS [7, 8], it seems to be a rational choice to use corticosteroids as part of the treatment. In the early 1980s, clinical investigators found that the inflammatory exudation in patients with ARDS could be decreased with systemic corticosteroid therapy [9]. Meduri and colleagues found that peripheral blood leukocytes, which are exposed to plasma from patients with ARDS, can produce inflammatory cytokines. Zhao et al BMC Pulmonary Medicine (2016) 16:29 in a case–control study, patients treated with corticosteroids were more infected by gram-negative bacteria and developed pneumonia more frequently [12]
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