Effects of methyl prednisolone in early ARDS

Abstract

Glucocorticoid induced down-regulation of systemic inflammation in ARDS is associated with a significant improvement in pulmonary and extrapulmonary organ dysfunction and a reduction in duration of mechanical ventilation and ICU length of stay [1]. We aimed in this study to evaluate the effect of methyl prednisolone when used early in ARDS. We studied 27 patients with ARDS, we divided them randomly into two groups the first group consists of 18 patients received methyl prednisolone and the other group consists of 9 patients did not receive it. All patients were subjected daily to: history taking and clinical examination, Chest X-ray, routine blood investigation (CBC–LFT–RFT–electrolytes), ABG, Serum lactate, INR, fibrinogen, and aptt, CRP, protein C, protein S, and D-dimer at the beginning and at the end of study. After 7 days there were significant improvements of clinical parameters (pulse, temperature, and systolic blood pressure), peep (one parameter from lung injury score), lactate, D-dimer, AST, and a highly significant improvement of creatinine in the methyl prednisolone group when compared to the control group. After 14 days from starting treatment there were significant improvements of clinical parameters (pulse and systolic BP), ventilator parameters (FIO2, peep, and RR), systemic inflammation markers organ functions (O2sat, lactate, creatinine, WBCs, AST, and GGT) and CRP. And a significant improvement of CX-ray, earlier extubation from mechanical ventilation and improvement of mortality in the methyl prednisolone group when compared with the control group. We conclude that methyl prednisolone when used on first 2 days in ARDS patients improves the LIS, decreases the systemic inflammation, earlier extubation from mechanical ventilation, and decreases the incidence of hospital acquired infection.