The acute respiratory distress syndrome(ARDS) that develops after thoracic surgery is usually lethal. The use of corticosteroids to treat ARDS has been the subject of great controversy. We evaluated the efficacy and safety of low-dose methylprednisolone therapy at an early phase of postoperative ARDS.
We compared conventional therapy with early low-dose steroid therapy in the treatment of postoperative ARDS. Methylprednisolone sodium succinate(MPSS) was given daily as an intravenous push every 6 hours with a loading dose of 2mg/kg followed by 2mg/kg per day as soon as ARDS was confirmed. Initially, steroid tapering was not begun until dyspnea and chest infiltrates had improved. Since prospective phase II study, MPSS was continued until seven day after study entry and began slow tapering for 4 days. After discontinued, MPSS was changed into oral prednisolone.
Between 2001 and 2004, 743 major thoracic operations for lung cancer and esophageal cancer were performed, of which 441(59.4%) were lobectomies, 88(11.8%) were pneumonectomies, 158(21.3%) were esophageal operations, and 56(7.5%) were multiple wedge resections. Postoperative ARDS was developed in 31 patients(4.17%), of which 8 were treated with conventional therapy and 23 with early low-dose steroid therapy. Death from ARDS accounted for 52.6%(n=10) of all deaths. The mortality of the conventional therapy group was 87.5% (7/8) and that of the early low-dose steroid therapy group was 13.0% (3/23). Follow up chest high-resolution computed tomography showed that 18 of 20 survivors in early low-dose steroid group were completely resolved from ARDS (figure).
This study revealed that early administration of low-dose methylprednisolone significantly reduced mortality from postoperative ARDS. The beneficial effects of the use of early low-dose steroids in ARDS are consistent with the hypothesis that fibroproliferation is an early response to lung injury, which is inhibited by early low-dose steroid therapy without disturbing operative wound healing.
Low-dose methylprednisolone administration at an early phase of ARDS will have beneficial effects on mortality and improve the quality of life of ARDS survivors.
H. Lee, None.