Abstract
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 [1–3]. In order to achieve partial or total resolution of ARDS, an innate or treatment-induced downregulation of systemic inflammation may be required [1]. Glucocorticoids, as end-effectors of the hypothalamic-pituitary-adrenal (HPA) axis, are the most important physiologic inhibitors of inflammation [4] affecting genes involved in stress-related homeostasis [5]. 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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
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 12:321–338
Meduri GU, Yates CR (2004) Systemic inflammation-associated glucocorticoid resistance and outcome of ARDS. Ann N Y Acad Sci 1024:24–53
Parsons PE, Eisner MD, Thompson BT, et al (2005) Lower tidal volume ventilation and plasma cytokine markers of inflammation in patients with acute lung injury. Crit Care Med 33:1–6
Rhen T, Cidlowski JA (2005) Antiinflammatory action of glucocorticoids-new mechanisms for old drugs. N Engl J Med 353:1711–1723
Galon J, Franchimont D, Hiroi N, et al (2002) Gene profiling reveals unknown enhancing and suppressive actions of glucocorticoids on immune cells. FASEB J 16:61–71
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 165:983–991
Ashbaugh DG, Bigelow DB, Petty TL, Levine BE (1967) Acute respiratory distress syndrome. Lancet 2:319–323
Bernard GR, Artigas A, Bringham KL, et al (1994) The American-European consensus conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149:818–824
Villar J, Mendez-Perez L, Lopez J, et al (2007) An early PEEP/FiO2 trial identifies different degrees of lung injury in ARDS patients. Am J Respir Crit Care Med 176:795–804
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]
Pelosi P, Rocco PR, Negrini D, Passi A (2007) The extracellular matrix of the lung and its role in edema formation. An Acad Bras Cienc 79:285–297
Souza-Fernandes AB, Pelosi P, Rocco PR (2006) Bench to Bedside Review: the role of glycosaminoglycans in respiratory disease. Crit Care 10:237
Moriondo A, Pelosi P, Passi A, et al (2007) Proteoglycan fragmentation and respiratory mechanics in mechanically ventilated healthy rats. J Appl Physiol 103:747–756
Ware LB, Matthay MA (2005) Clinical practice. Acute pulmonary edema. N Engl J Med 253:2788–2796
Guidot DM, Folkesson HG, Jain L, Sznajder JI, Pittet JF, Matthay MA (2006) Integrating acute lung injury and regulation of alveolar fluid clearance. Am J Physiol Lung Cell Mol Physiol 291:L301–L306
Matthay MA, Zimmerman GA (2005) Acute lung injury and the acute respiratory distress syndrome: four decades of inquiry into pathogenesis and rational management. Am J Respir Cell Mol Biol 33:319–327
Suter PM (2006) Lung inflammation in ARDS: friend or foe? N Engl J Med 354:1739–1742
Ware LB, Camerer E, Welty-Wolf K, Schultz MJ, Matthay MA (2006) Bench to bedside: targeting coagulation and fibrinolysis in acute lung injury. Am J Physiol Lung Cell Mol Physiol 291:L307–L311
Calfee CS, Matthay MA (2007) Non ventilatory treatments for acute lung injury and ARDS. Chest 131:913–920
Ware LB, Matthay MA (2000) The acute respiratory distress syndrome. N Engl J Med 342: 1334–1349
Martin C, Papazian L, Payan MJ, Saux P, Gouin F (1995) Pulmonary fibrosis correlates with outcome in adult respiratory distress syndrome. A study in mechanically ventilated patients. Chest 107:196–200
Chesnutt AN, Matthay MA, Tibayan FA, Clark JG (1997) Early detection of type III procollagen peptide in acute lung injury. Pathogenetic and prognostic significance. Am J Respir Crit Care Med 156:840–845
Rocco PRM, Negri EM, Kurtz PM, et al (2001) Lung tissue mechanics and extracellular matrix in acute lung injury. Am J Respir Crit Care Med 164:1067–1071
Marshall RP, Bellingan G, Webb S, et al (2000) Fibroproliferation occurs early in the acute respiratory distress syndrome and impacts on outcome. Am J Respir Crit Care Med 162: 1783–1788
Meduri GU, Marik PE, Pastores SM, Annane D, Calfee CS, Matthay MA (2007) Corticosteroids in ARDS: a counterpoint. Chest 132:1093–1094
Cooper MS, Stewart PM (2003) Corticosteroid insufficiency in acutely ill patients. N Engl J Med 348:727–734
Fernandes ABS, Zin WA, Rocco PRM (2005) Corticosteroids in acute respiratory distress syndrome. Braz J Med Biol Res 38:147–159
Shiue ST, Thrall RS (1991) Effect of corticosteroid therapy on the acute injury and recovery stage of oleic acid induced lung injury in the rat. Experiment Lung Res 17:629–638
Jones RL, King RG (1975) The effects of methylprednisolone on oxygenation in experimental hypoxemic respiratory failure. J Trauma 15:297–303
Cheney FW, Hung TH, Gronka R (1979) Effects of methylprednisolone on experimental pulmonary injury. Ann Surg 190:236–242
Volpe BT, Lin W, Thrall RS (1994) Effect of intratracheal dexamethasone on oleic acidinduced lung injury in the rat. Chest 106:583–587
Kuwabara K, Furue S, Tomita Y, et al (2001) Effect of methylprednisolone on phospholipase A2 activity and lung surfactant degradation in acute lung injury in rats. Eur J Pharmacol 433:209–216
London L, Majeski E, Altman-Hamamdzic S, et al (2002) Respiratory reovirus 1/L induction of diffuse alveolar damage: pulmonary fibrosis is not modulated by corticosteroids in acute respiratory distress syndrome in rats. Clin Immunol 103:284–295
Rocco PRM, Souza AB, Faffe DS, et al (2003) Effect of corticosteroid on lung parenchyma remodeling at an early phase of acute lung injury. Am Respir Crit Care Medicine 168: 677–684
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)
Weigelt JA, Norcross JR, Borman KR, Snyder WH (1985) Early steroid therapy for respiratory failure. Arch Surg 120:536–540
Bone RC, Fisher Jr CJ, Clemmer TP, Slotman GJ, Metz CA (1987) Early methylprednisolone treatment for septic syndrome and the adult respiratory distress syndrome. Chest 92:1032–1036
Bernard GR, Luce JM, Sprung CL, et al (1987) High dose corticosteroids in patients with the adult respiratory distress syndrome. N Engl J Med 317:1565–1570
Luce JM, Montgomery AB, Marks JD, Turner J, Metz CA, Murray JF (1988) Ineffectiveness of high-dose methylprednisolone in preventing parenchymal lung injury and improving mortality in patients with septic shock. Am Rev Respir Dis 138:62–68
Schonfeld SA, Ploysongsang Y, DiLisio R, et al (1983) Fat embolism prophylaxis with corticosteroids: a prospective study in high risk patients. Ann Intern Med 99:438–443
Bozzette SA, Sattler FR, Chiu J, et al (1990) A controlled trial of early adjunctive treatment with corticosteroids for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. N Engl J Med 323:1451–1457
Gagnon S, Boota AM, Fischl MA, Baier H, Kirksey OW, La Voie L (1990). Corticosteroids as adjunctive therapy for severe Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome: A double-blind, placebo-controlled trial. N Engl J Med, 323:1444–1450
Meduri GU (1999) A historical review of glucocorticoid treatment in sepsis: disease pathophysiology and the design of treatment investigation. Sepsis 3:21–28
Lee HS, Lee JM, Kim MS, Kim HY, Hwangbo B, Zo JI (2005) Low dose steroid therapy at an early phase of postoperative acute respiratory distress syndrome. Ann Thorac Surg 79:405–410
Confalonieri M, Urbino R, Potena A, et al (2005) Hydrocortisone infusion for severe community-acquired pneumonia: a preliminary randomized study. Am J Respir Crit Care Med 171: 242–248
Meduri GU, Golden E, Freire AX, et al (2007) Methylprednisolone infusion in early severe ARDS: results of a randomized controlled trial. Chest 131:954–963
Meduri GU, Headley S, Golden E, et al (1998) Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome. A randomized controlled trial. JAMA 280:159–165
Steinberg KP, Hudson LD, Goodman RB, et al (2006) Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med 354:1671–1684
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2008 Springer Science + Business Media Inc.
About this paper
Cite this paper
Pelosi, P., Rocco, P.R.M. (2008). Glucocorticoid Treatment in Acute Respiratory Distress Syndrome: Friend or Foe?. In: Vincent, JL. (eds) Intensive Care Medicine. Springer, New York, NY. https://doi.org/10.1007/978-0-387-77383-4_20
Download citation
DOI: https://doi.org/10.1007/978-0-387-77383-4_20
Publisher Name: Springer, New York, NY
Print ISBN: 978-0-387-77382-7
Online ISBN: 978-0-387-77383-4
eBook Packages: MedicineMedicine (R0)