Abstract

OBJECTIVE
To determine the effects of low-dose prolonged methylprednisolone infusion on lung function in patients with early severe ARDS.
DESIGN
Randomized, double-blind, placebo-controlled trial.
SETTING
ICUs of five hospitals in Memphis.
PARTICIPANTS
Ninety-one patients with severe early ARDS (</= 72 h), 66% with sepsis.
INTERVENTIONS
Patients were randomized (2:1 fashion) to methylprednisolone infusion (1 mg/kg/d) vs placebo. The duration of treatment was up to 28 days. Infection surveillance and avoidance of paralysis were integral components of the protocol.
MAIN OUTCOME MEASURE
The predefined primary end point was a 1-point reduction in lung injury score (LIS) or successful extubation by day 7.
RESULTS
In intention-to-treat analysis, the response of the two groups (63 treated and 28 control) clearly diverged by day 7, with twice the proportion of treated patients achieving a 1-point reduction in LIS (69.8% vs 35.7%; p = 0.002) and breathing without assistance (53.9% vs 25.0%; p = 0.01). Treated patients had significant reduction in C-reactive protein levels, and by day 7 had lower LIS and multiple organ dysfunction syndrome scores. Treatment was associated with a reduction in the duration of mechanical ventilation (p = 0.002), ICU stay (p = 0.007), and ICU mortality (20.6% vs 42.9%; p = 0.03). Treated patients had a lower rate of infections (p = 0.0002), and infection surveillance identified 56% of nosocomial infections in patients without fever.
CONCLUSIONS
Methylprednisolone-induced down-regulation of systemic inflammation was associated with significant improvement in pulmonary and extrapulmonary organ dysfunction and reduction in duration of mechanical ventilation and ICU length of stay.

Links

Publisher Full Text

Authors

Meduri GU, Golden E, Freire AX, Taylor E, Zaman M, Carson SJ, Gibson M, Umberger R

Institution

Division of Pulmonary, Critical Care, and Sleep Medicine, University of Tennessee Health Science Center, 956 Court Ave, Room H316, Memphis, TN 38163, USA. umeduri@utmem.edu

Source

Chest 131:4 2007 Apr pg 954-63

MeSH

C-Reactive Protein
Catecholamines
Dose-Response Relationship, Drug
Female
Fluorescence Polarization Immunoassay
Follow-Up Studies
Glucocorticoids
Hospital Mortality
Humans
Hydrocortisone
Infusions, Intravenous
Length of Stay
Male
Methylprednisolone
Middle Aged
Respiration, Artificial
Respiratory Care Units
Respiratory Distress Syndrome, Adult
Retrospective Studies
Time Factors
Treatment Outcome

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17426195