Established ARDS Treated with a Sustained Course of Adrenocortical Steroids

Adrenocortical Steroids

The word, “controversy,” is repeatedly used to describe the debate surrounding the use of ACS in patients suffering from ARDS. Prominent clinicians and scientists are on opposite sides of the issue quoting well-done work to support their views. Recent carefully performed studies have shown short-term, high-dose adrenocortical steroids do not improve ul­timate outcome. Our experience has led us to question further the use of these agents in this complicated problem. What is the effect of a longer course of therapy? Can patient selection identify a group or subset who may respond to this therapy? What are the implications of gallium uptake by ARDS lungs for pathogenesis and therapy?

When confronted with a patient who was persist­ently ventilator-dependent due to ARDS, one of the authors utilized Ga citrate scanning to identify if a potentially reversible inflammatory component ex­isted within the diffuse pulmonary process. A surpris­ing degree of Ga uptake was present. Adrenocortical steroids were administered and a clinical improvement followed, lapering of the ACS was followed by dete­rioration in respiratory function. Reinstitution then led to further improvement and subsequent resolu­tion. In a second case, a similar pattern of events was observed. silagra tablets

These two clinical experiences stimulated us to utilize a sustained course of ACS in the treatment of patients with established ARDS, since short treatment courses have been shown to be of no demonstrable value. Our experience in an uncontrolled patient population provides suggestive evidence that a sus­tained course of ACS is beneficial in the treatment of established ARDS. The dosages of ACS administered; duration for which we employed them; and the patients we selected to treat all differ significantly from those utilized in studies arguing against their value. Our experience suggests a need for further controlled studies of the use of ACS in patients with established ARDS.

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