Improved Oxygenation by Steroid Pulse Therapy in Early-Phase Acute Respiratory Distress Syndrome

Abstract

Objective and Background: Although short-duration, high-dose glucocorticoid therapy is reportedly ineffective for early-phase acute respiratory distress syndrome (ARDS), steroid pulse therapy is often used in Japan for life-threatening cases because of its beneficial effects on oxygenation. Thus, we evaluated the effect of steroid pulse therapy on oxygenation for early-phase ARDS. Method: Cases of early-phase ARDS treated with steroid pulse therapy in intensive care units of four critical care medical centers in Japan from 2000 to 2003 were investigated. Clinical course and serial changes in PaO2/FIO2 ratio were evaluated. Results: Twenty-nine patients received methylprednisolone 1 g/day for 3 days; 20 patients subsequently received prolonged methylprednisolone treatment. Causes of ARDS were pneumonia (n=23), extrapulmonary sepsis (n=4) and other factors (n=2). The overall mortality rate was 24.1%. PaO2/FIO2 ratios improved significantly after initiation of steroid pulse therapy, in comparison to pretreatment values (day 0: 119.8 ± 30.6, day 1: 172.1 ± 63.7*, day 2: 196.4 ± 90.0*, day 3: 218.4 ± 92.0*, mean ± SD, *p < 0.05 vs. day 0). Significant improvement in oxygenation was observed in both survivors and non-survivors, but the PaO2/FIO2 ratio in non-survivors subsequently deteriorated. In seven patients with life-threatening hypoxemia (PaO2/FIO2 ratio < 100 at day 0), oxygenation improved significantly after pulse treatment; five of these patients survived. Conclusions: Three day steroid pulse therapy can improve oxygenation in patients with progressive ARDS even in the early phase. Steroid therapy for early-phase ARDS should be reconsidered.