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Glucocorticoid rescue for late-phase acute respiratory distress syndrome in trauma/surgical critical care patients.
Am Surg. 2006 Jul; 72(7):644-8.AS

Abstract

High-dose glucocorticoid therapy (GCT) for the late fibroproliferative phase of acute respiratory distress syndrome (ARDS) is controversial and has shown mixed results in medical patients. No studies have evaluated GCT in trauma/surgical critical care patients. The purpose of this study is to review the outcomes of trauma/surgical critical care patients with refractory ARDS treated with GCT. From January 2001 through September 2005, a pharmacy log was used to identify critically ill trauma/surgical patients in refractory ARDS (7 males and 2 females) who received GCT in an attempt to salvage them. GCT consisted of 200 mg intravenous methylprednisolone bolus for one dose and then 3 mg/kg per day divided every 6 hours for 6 weeks or until weaned off the ventilator. All patients as well as the survivors were analyzed. Outcome data was analyzed with SPSS (Chicago, IL) and the paired sample test. A P value < or = 0.05 was considered significant. Data is presented as mean +/- standard deviation. The Institutional Review Board approved this retrospective chart review. Seven patients (6 males and 1 female; age, 31 +/- 16 years) survived (78%), weaned off of the ventilator, and were discharged from the hospital. The 2 deaths were secondary to refractory respiratory failure as well as cardiac arrest (n = 1) and anoxic brain injury from septic hypotension (n = 1). In survivors (n = 7), hospital length of stay (LOS) and intensive care unit LOS was 71 +/- 30 days and 53 +/- 16 days, respectively. Duration of GCT administration was 17 +/- 6.4 days (range, 11-30 days). Ventilator time before GCT, during GCT, and after GCT was 22 +/- 8.4, 15 +/- 7.5, and 1.6 +/- 6.0 days, respectively. During GCT, 8 patients developed pneumonia, 5 had urinary tract infection, and 3 had bacteremia. All infections were effectively treated with broad-spectrum antibiotics, except in one patient who died of sepsis. PaO2/FIO2 ratio just before and after GCT was 100 +/- 36 and 247 +/- 56, respectively (n = 7; P < 0.001). Sequential organ failure assessment score just before and after GCT was 9.1 +/- 2.3 and 5.0 +/- 1.6, respectively (n = 7; P < 0.001). GCT rescue may have a role in salvaging critically ill trauma/surgical critical care patients in late-stage ARDS. More patients, however, need to be studied.

Authors+Show Affiliations

Department of Surgery, University of Tennessee College of Medicine-Chattanooga Unit, Chattanooga, Tennessee 37403, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16875090

Citation

Koontz, Curt S., et al. "Glucocorticoid Rescue for Late-phase Acute Respiratory Distress Syndrome in Trauma/surgical Critical Care Patients." The American Surgeon, vol. 72, no. 7, 2006, pp. 644-8.
Koontz CS, Higdon KK, Ploger TL, et al. Glucocorticoid rescue for late-phase acute respiratory distress syndrome in trauma/surgical critical care patients. Am Surg. 2006;72(7):644-8.
Koontz, C. S., Higdon, K. K., Ploger, T. L., Dart, B. W., Richart, C. M., & Maxwell, R. A. (2006). Glucocorticoid rescue for late-phase acute respiratory distress syndrome in trauma/surgical critical care patients. The American Surgeon, 72(7), 644-8.
Koontz CS, et al. Glucocorticoid Rescue for Late-phase Acute Respiratory Distress Syndrome in Trauma/surgical Critical Care Patients. Am Surg. 2006;72(7):644-8. PubMed PMID: 16875090.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Glucocorticoid rescue for late-phase acute respiratory distress syndrome in trauma/surgical critical care patients. AU - Koontz,Curt S, AU - Higdon,K Kye, AU - Ploger,Troy L, AU - Dart,Benjamin W,4th AU - Richart,Charles M, AU - Maxwell,Robert A, PY - 2006/8/1/pubmed PY - 2006/9/1/medline PY - 2006/8/1/entrez SP - 644 EP - 8 JF - The American surgeon JO - Am Surg VL - 72 IS - 7 N2 - High-dose glucocorticoid therapy (GCT) for the late fibroproliferative phase of acute respiratory distress syndrome (ARDS) is controversial and has shown mixed results in medical patients. No studies have evaluated GCT in trauma/surgical critical care patients. The purpose of this study is to review the outcomes of trauma/surgical critical care patients with refractory ARDS treated with GCT. From January 2001 through September 2005, a pharmacy log was used to identify critically ill trauma/surgical patients in refractory ARDS (7 males and 2 females) who received GCT in an attempt to salvage them. GCT consisted of 200 mg intravenous methylprednisolone bolus for one dose and then 3 mg/kg per day divided every 6 hours for 6 weeks or until weaned off the ventilator. All patients as well as the survivors were analyzed. Outcome data was analyzed with SPSS (Chicago, IL) and the paired sample test. A P value < or = 0.05 was considered significant. Data is presented as mean +/- standard deviation. The Institutional Review Board approved this retrospective chart review. Seven patients (6 males and 1 female; age, 31 +/- 16 years) survived (78%), weaned off of the ventilator, and were discharged from the hospital. The 2 deaths were secondary to refractory respiratory failure as well as cardiac arrest (n = 1) and anoxic brain injury from septic hypotension (n = 1). In survivors (n = 7), hospital length of stay (LOS) and intensive care unit LOS was 71 +/- 30 days and 53 +/- 16 days, respectively. Duration of GCT administration was 17 +/- 6.4 days (range, 11-30 days). Ventilator time before GCT, during GCT, and after GCT was 22 +/- 8.4, 15 +/- 7.5, and 1.6 +/- 6.0 days, respectively. During GCT, 8 patients developed pneumonia, 5 had urinary tract infection, and 3 had bacteremia. All infections were effectively treated with broad-spectrum antibiotics, except in one patient who died of sepsis. PaO2/FIO2 ratio just before and after GCT was 100 +/- 36 and 247 +/- 56, respectively (n = 7; P < 0.001). Sequential organ failure assessment score just before and after GCT was 9.1 +/- 2.3 and 5.0 +/- 1.6, respectively (n = 7; P < 0.001). GCT rescue may have a role in salvaging critically ill trauma/surgical critical care patients in late-stage ARDS. More patients, however, need to be studied. SN - 0003-1348 UR - https://www.unboundmedicine.com/medline/citation/16875090/Glucocorticoid_rescue_for_late_phase_acute_respiratory_distress_syndrome_in_trauma/surgical_critical_care_patients_ L2 - http://www.diseaseinfosearch.org/result/210 DB - PRIME DP - Unbound Medicine ER -