Glucocorticoid Treatment in Acute Respiratory Distress Syndrome: Friend or Foe?
In the early phases of acute respiratory distress syndrome (ARDS) the evolution of systemic and pulmonary inflammation during mechanical ventilation determines the physiological progression (resolving or unresolving) and outcome of the disease [1, 2, 3]. In order to achieve partial or total resolution of ARDS, an innate or treatment-induced downregulation of systemic inflammation may be required . Glucocorticoids, as end-effectors of the hypothalamic-pituitary-adrenal (HPA) axis, are the most important physiologic inhibitors of inflammation  affecting genes involved in stress-related homeostasis . Recent studies have shown that systemic inflammation-induced glucocorticoid receptor resistance and/or insensitivity is an acquired, generalized process central to the pathogenesis of unresolving ARDS that is potentially reversed by quantitatively adequate and prolonged glucocorticoid supplementation [1, 2, 6]. This chapter will review the mechanisms of action of corticosteroids and the results of experimental and clinical studies on the use of corticosteroids in ARDS.
KeywordsGlucocorticoid Receptor Acute Lung Injury Acute Respiratory Distress Syndrome Acquire Immune Deficiency Syndrome Respir Crit
Unable to display preview. Download preview PDF.
- 1.Meduri GU, Muthiah MP, Carratu P, Eltorky M, Chrousos GP (2005) Nuclear factor-kappaB-and glucocorticoid receptor alphamediated mechanisms in the regulation of systemic and pulmonary inflammation during sepsis and acute respiratory distress syndrome. Evidence for inflammation-induced target tissue resistance to glucocorticoids. Neuroimmunomodulation 12:321–338PubMedCrossRefGoogle Scholar
- 6.Meduri GU, Tolley EA, Chrousos GP, Stentz F (2002) Prolonged methylprednisolone treatment suppresses systemic inflammation in patients with unresolving acute respiratory distress syndrome. Evidence for inadequate endogenous glucocorticoid secretion and inflammationinduced immune cell resistance to glucocorticoids. Am J Respir Crit Care Med 165:983–991PubMedGoogle Scholar
- 10.Esteban A, Ferguson ND, Meade MO et al (2007) Evolution of mechanical ventilation in response to clinical research. Am J Respir Crit Care Med [Epub ahead of print]Google Scholar
- 35.Rocco PRM, Leite-Junior JHP, Bozza PT, et al (2006) Effects of corticosteroid on lung parenchyma remodeling in pulmonary and extrapulmonary acute lung injury. Proc Am Thorac Soc 3:838 (abst)Google Scholar