Abstract

The present study was designed to demonstrate the usefulness of corticosteroid therapy for the acute respiratoy insufficiency in acute pneumonias. Fifteen cases of acute pneumonia with respiratory insufficiency were treated with combination of broad spectrum antibiotics and steroid. And some experimental studies on this problem were investigated useing experimental rabbit pneumonia.The obtained results were as follows.1. The clinical cases were retospectively divided into two groups, such as responder group (10 cases) and non-responder one (5 cases). In the responder cases, the steroid therapy was started within 4 days after the onset of the pneumonias. The pneumonic shadows the cases in the chest X-ray was diminished rapidly (Av. 4.4 days±1.7 after the start of steroid therapy) and values of arterial Po2 were also recovered rapidly (Av. 3.5 days±1.4).In the non-responder group, the steroid therapy started at later stage (7.6 days±2.3) of the onset of the pneumonias. Three cases out of them were far-advanced pneumonias in high age and they died with cardiac failure at from 15th through 24th day. Other two cases were recovered, but the improvement in symptomes and Pao2-values was more delayed than that in the cases with early start of steroid therapy. From the above, the steroid therapy might be started. at the early stage of pneumonias, then the goodeffect will be expected.2. The impairment of alveolar oxygen exchanges was examined in the experimental rabbit pneumonia. The values of arterial Po2 were droppe by pneumonias. An inverse relationship was found to exist between them. Various degrees of increase in A-aDo2 were observed in animals with hypoxemia due to pneumonias. The true shunt ratio during mechanical ventilation of 100% 02 the values of the true shunt ratio were less than 14%. The values were markedly increased in the animals with pneumonias. And they are well related with decreased in values of the Pao2. The increase in the true shunt ratio seems likely to be the important factor in hypoxemia in pneunomias.On the other hand, in morphologic findings, the alveolar wall dominantly thickened with pneumonic infiltration and some of alveolar space were filled with pneumonic exudation. The increase in distance between alveolar gas and the capillary was suspected. The increase in true shunt ratio may be induced by such highly thickened alveolar walls seen in pneumonia. Corticosteroid may be useful for diminution of such highly thickened alveolar walls. The impairment of arterial Po2 was compared between the cases with monotherapy of CTX and the cases with combination therapy of CTX and corticosteroid in rabbit pneumonia. The recovery of arterial Po2 was more rapidly in the group of combination therapy. The evidence also may support the usefulness of corticosteroid against respiratory failure due to such highly thickened alveolar walls in pneumonia.3. From above results, we concluted as follow. Steroid therapy for acute respiratory insufficiency in pneumonia might be very useful, if it will be used under following indications.1) Steroid therapy must be started within 4th day of the onset of pneumomias.2) The value of arterial Pao2 is less than 60mmHg.3) The period of steroid therapy is in less than seven days, because the effect of it might be given very rapidly.

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