Prolonged glucocorticoid treatment and secondary prevention in acute respiratory distress syndrome

Gianfranco Meduri, Patricia R.M. Rocco, Djillali Annane, Scott Sinclair

Research output: Contribution to journalReview article

12 Citations (Scopus)

Abstract

Experimental and clinical evidence has demonstrated a strong association between dysregulated systemic inflammation and progression of acute respiratory distress syndrome (ARDS). In ARDS, glucocorticoid receptor-mediated downregulation of inflammation is essential to restore homeostasis and decrease morbidity and mortality. We review the findings of eight controlled studies (n = 569) evaluating treatment initiated before day 14 of ARDS. These trials consistently reported that treatment-induced reduction in systemic inflammation was associated with a significant improvement in ratio of partial arterial oxygen tension to fraction of inspired oxygen, and reductions in multiple organ dysfunction score, duration of mechanical ventilation and intensive care unit length of stay. Treatment was also associated with a marked reduction in the risk of death (relative risk: 0.68; 95% CI: 0.56-0.81; p < 0.001) and a sizable increase in mechanical ventilation-free days (weighted mean difference: 6.58 days; 95% CI: 2.93-10.23; p < 0.001); and intensive care unit-free days (weighted mean difference: 7.02 days; 95% CI: 3.20-10.85; p < 0.001). We recommend that prolonged methylprednisolone treatment, at an initial dose of 1 mg/kg/day in early ARDS and 2 mg/kg/day in unresolving ARDS, be delivered as an infusion to avoid glycemic variability, and that infection surveillance be strictly implemented to identify infections in the absence of fever.

Original languageEnglish (US)
Pages (from-to)201-210
Number of pages10
JournalExpert Review of Respiratory Medicine
Volume4
Issue number2
DOIs
StatePublished - Apr 1 2010

Fingerprint

Adult Respiratory Distress Syndrome
Secondary Prevention
Glucocorticoids
Inflammation
Artificial Respiration
Intensive Care Units
Organ Dysfunction Scores
Oxygen
Therapeutics
Glucocorticoid Receptors
Methylprednisolone
Risk Reduction Behavior
Infection
Length of Stay
Arterial Pressure
Homeostasis
Fever
Down-Regulation
Morbidity
Mortality

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Pulmonary and Respiratory Medicine
  • Public Health, Environmental and Occupational Health

Cite this

Prolonged glucocorticoid treatment and secondary prevention in acute respiratory distress syndrome. / Meduri, Gianfranco; Rocco, Patricia R.M.; Annane, Djillali; Sinclair, Scott.

In: Expert Review of Respiratory Medicine, Vol. 4, No. 2, 01.04.2010, p. 201-210.

Research output: Contribution to journalReview article

@article{22dfc47d83ca421a890ffed8e9c8ddf6,
title = "Prolonged glucocorticoid treatment and secondary prevention in acute respiratory distress syndrome",
abstract = "Experimental and clinical evidence has demonstrated a strong association between dysregulated systemic inflammation and progression of acute respiratory distress syndrome (ARDS). In ARDS, glucocorticoid receptor-mediated downregulation of inflammation is essential to restore homeostasis and decrease morbidity and mortality. We review the findings of eight controlled studies (n = 569) evaluating treatment initiated before day 14 of ARDS. These trials consistently reported that treatment-induced reduction in systemic inflammation was associated with a significant improvement in ratio of partial arterial oxygen tension to fraction of inspired oxygen, and reductions in multiple organ dysfunction score, duration of mechanical ventilation and intensive care unit length of stay. Treatment was also associated with a marked reduction in the risk of death (relative risk: 0.68; 95{\%} CI: 0.56-0.81; p < 0.001) and a sizable increase in mechanical ventilation-free days (weighted mean difference: 6.58 days; 95{\%} CI: 2.93-10.23; p < 0.001); and intensive care unit-free days (weighted mean difference: 7.02 days; 95{\%} CI: 3.20-10.85; p < 0.001). We recommend that prolonged methylprednisolone treatment, at an initial dose of 1 mg/kg/day in early ARDS and 2 mg/kg/day in unresolving ARDS, be delivered as an infusion to avoid glycemic variability, and that infection surveillance be strictly implemented to identify infections in the absence of fever.",
author = "Gianfranco Meduri and Rocco, {Patricia R.M.} and Djillali Annane and Scott Sinclair",
year = "2010",
month = "4",
day = "1",
doi = "10.1586/ers.10.2",
language = "English (US)",
volume = "4",
pages = "201--210",
journal = "Expert Review of Respiratory Medicine",
issn = "1747-6348",
publisher = "Expert Reviews Ltd.",
number = "2",

}

TY - JOUR

T1 - Prolonged glucocorticoid treatment and secondary prevention in acute respiratory distress syndrome

AU - Meduri, Gianfranco

AU - Rocco, Patricia R.M.

AU - Annane, Djillali

AU - Sinclair, Scott

PY - 2010/4/1

Y1 - 2010/4/1

N2 - Experimental and clinical evidence has demonstrated a strong association between dysregulated systemic inflammation and progression of acute respiratory distress syndrome (ARDS). In ARDS, glucocorticoid receptor-mediated downregulation of inflammation is essential to restore homeostasis and decrease morbidity and mortality. We review the findings of eight controlled studies (n = 569) evaluating treatment initiated before day 14 of ARDS. These trials consistently reported that treatment-induced reduction in systemic inflammation was associated with a significant improvement in ratio of partial arterial oxygen tension to fraction of inspired oxygen, and reductions in multiple organ dysfunction score, duration of mechanical ventilation and intensive care unit length of stay. Treatment was also associated with a marked reduction in the risk of death (relative risk: 0.68; 95% CI: 0.56-0.81; p < 0.001) and a sizable increase in mechanical ventilation-free days (weighted mean difference: 6.58 days; 95% CI: 2.93-10.23; p < 0.001); and intensive care unit-free days (weighted mean difference: 7.02 days; 95% CI: 3.20-10.85; p < 0.001). We recommend that prolonged methylprednisolone treatment, at an initial dose of 1 mg/kg/day in early ARDS and 2 mg/kg/day in unresolving ARDS, be delivered as an infusion to avoid glycemic variability, and that infection surveillance be strictly implemented to identify infections in the absence of fever.

AB - Experimental and clinical evidence has demonstrated a strong association between dysregulated systemic inflammation and progression of acute respiratory distress syndrome (ARDS). In ARDS, glucocorticoid receptor-mediated downregulation of inflammation is essential to restore homeostasis and decrease morbidity and mortality. We review the findings of eight controlled studies (n = 569) evaluating treatment initiated before day 14 of ARDS. These trials consistently reported that treatment-induced reduction in systemic inflammation was associated with a significant improvement in ratio of partial arterial oxygen tension to fraction of inspired oxygen, and reductions in multiple organ dysfunction score, duration of mechanical ventilation and intensive care unit length of stay. Treatment was also associated with a marked reduction in the risk of death (relative risk: 0.68; 95% CI: 0.56-0.81; p < 0.001) and a sizable increase in mechanical ventilation-free days (weighted mean difference: 6.58 days; 95% CI: 2.93-10.23; p < 0.001); and intensive care unit-free days (weighted mean difference: 7.02 days; 95% CI: 3.20-10.85; p < 0.001). We recommend that prolonged methylprednisolone treatment, at an initial dose of 1 mg/kg/day in early ARDS and 2 mg/kg/day in unresolving ARDS, be delivered as an infusion to avoid glycemic variability, and that infection surveillance be strictly implemented to identify infections in the absence of fever.

UR - http://www.scopus.com/inward/record.url?scp=77951449833&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77951449833&partnerID=8YFLogxK

U2 - 10.1586/ers.10.2

DO - 10.1586/ers.10.2

M3 - Review article

VL - 4

SP - 201

EP - 210

JO - Expert Review of Respiratory Medicine

JF - Expert Review of Respiratory Medicine

SN - 1747-6348

IS - 2

ER -