Steroids in ARDS: to be or not to be

Bihari, Shailesh; Bailey, Michael; Bersten, Andrew D.

doi:10.1007/s00134-015-4135-0

Cited by 15 publications

(12 citation statements)

References 25 publications

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“…In the present study, all patients were treated in this manner. Low-dose corticosteroid therapy is reportedly associated with reductions in mortality, duration of mechanical ventilation and length of stay in the ICU, but the available evidence remains contradictory [38][39][40]. No significant differences in 28-day survival or ICU survival were seen between patients with or without corticosteroid therapy in our results.…”

Section: Discussionmentioning

confidence: 44%

A predictive factor for patients with acute respiratory distress syndrome: CT lung volumetry of the well-aerated region as an automated method

Nishiyama

Kawata

Yokota

et al. 2020

European Journal of Radiology

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Section: Discussionmentioning

confidence: 44%

A predictive factor for patients with acute respiratory distress syndrome: CT lung volumetry of the well-aerated region as an automated method

Nishiyama

Kawata

Yokota

et al. 2020

European Journal of Radiology

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“…Clinical trials on ARDS patients and subsequent meta analyses (Steinberg et al ; Foster ; Yehya et al ; Meduri et al ; Kimura et al ; Tongyoo et al ; Standiford and Ward ; Yang et al ; Fan et al ) as well as experimental studies in animal models of acute lung injury (ALI) (Chen et al ; Leite‐Junior et al ; Wang et al ; Xu et al ; Yubero et al ; Hegeman et al ; Engel et al ) have indicated that glucocorticoids (e.g., methylprednisolone, dexamethasone, hydrocortisone) elicit variable effects as a function of the dose, the route of administration, the time to treatment initiation and duration, the age of the patient, the cause of ARDS/type of ALI model and/or the measured outcomes. Therefore, the available evidence for glucocorticoids benefits in ARDS is conflicting and the use of these treatments in ARDS patients are still subject to debate (Bein et al ; Bihari et al ; Seam and Suffredini ; Thompson and Ranieri ; Mac and McAuley ; Meduri and Siemieniuk ; Bos et al ).…”

Section: Introductionmentioning

confidence: 99%

Dexamethasone fails to improve bleomycin‐induced acute lung injury in mice

et al. 2019

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Acute respiratory distress syndrome (ARDS) features an exudative phase characterized by alveolar damage, lung edema and exacerbated inflammatory response. Given their anti‐inflammatory properties, the potential therapeutic effect of corticosteroids has been evaluated in ARDS clinical trials and experimental models of ALI. These studies produced contradictory results. Therefore, our aim was to investigate the effects of dexamethasone in an animal model of bleomycin‐induced acute lung injury and then to determine if the lack of response could be related to an impairment in repair ability of alveolar epithelial cells after injury. NMRI mice were challenged with bleomycin and then treated daily with dexamethasone or saline. Bronchoalveolar lavages (BAL) and lungs were collected for assessment of the inflammatory response and wet/dry ratio (lung edema) and for histological analyses. The effect of bleomycin and dexamethasone on wound repair was also evaluated in vitro on primary alveolar epithelial cell (ATII) cultures. Our data first showed that dexamethasone treatment did not reduce the weight loss or mortality rates induced by bleomycin. Although the TNF‐α level in BAL of bleomycin‐treated mice was reduced by dexamethasone, the neutrophil infiltration remained unchanged. Dexamethasone also failed to reduce lung edema and damage scores. Finally, bleomycin elicited a time‐ and dose‐dependent reduction in repair rates of ATII cell cultures. This inhibitory effect was further enhanced by dexamethasone, which also affected the expression of β3‐ and β6‐integrins, key proteins of alveolar repair. Altogether, our data indicate that the inability of dexamethasone to improve the resolution of ALI might be due to his deleterious effect on the alveolar epithelium repair.

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“…The steroid response of acute fibrinous OP is intermediate, between that of diffuse alveolar damage and OP. 3 To the best of our knowledge, few cases of postinfluenza OP have been reported in the literature. 4,5 Most were influenza A infection and patients usually presented with refractory respiratory failure, incomplete recovery, or new radiological infiltrate after initial improvement.…”

Section: Discussionmentioning

confidence: 99%

Secondary organising pneumonia complicating acute respiratory distress syndrome caused by severe influenza A: a case report

Yeung

Wong

2020

Hong Kong Med J

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A 69-year-old man with a history of diabetes mellitus and benign prostatic hypertrophy was admitted to our medical unit with a 1-week history of fever, runny nose, and shortness of breath. Chest X-ray revealed bilateral diffuse ground glass opacities in both lung fields. The patient had type 1 respiratory failure and required non-invasive positive pressure ventilation to maintain oxygenation. The patient was given ceftriaxone 1 g every 12 hours, and doxycycline 100 mg and oseltamivir 75 mg twice daily. He was transferred to the intensive care unit and intubated due to severe acute respiratory distress syndrome (ARDS). The patient's nasopharyngeal swab was tested by polymerase chain reaction and the result was positive for influenza A virus H1 RNA. His clinical course was further complicated by septic acute kidney injury that necessitated continuous venovenous haemofiltration. His lungs gradually improved with supportive measures including prone ventilation and muscle paralysis for 48 hours. The fractional oxygenation requirement improved from 1.0 to 0.4 between day 1 and day 8 of admission and chest X-ray showed improving aeration of both lungs.

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Steroids in ARDS: to be or not to be

Cited by 15 publications

References 25 publications

A predictive factor for patients with acute respiratory distress syndrome: CT lung volumetry of the well-aerated region as an automated method

A predictive factor for patients with acute respiratory distress syndrome: CT lung volumetry of the well-aerated region as an automated method

Dexamethasone fails to improve bleomycin‐induced acute lung injury in mice

Secondary organising pneumonia complicating acute respiratory distress syndrome caused by severe influenza A: a case report

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