Late steroid therapy improves gas exchange and reduces organ dysfunction in acute lung injury caused by pneumococcal pneumonia

Introduction

Prophylactic or early glucocorticoid therapy have not proved to be useful in the treatment of acute lung injury (ALI). However, there is evidence of the beneficial effects of steroids in the fibroproliferative stage of ALI (late steroid therapy).

Materials and methods

We analyzed the clinical data of all patients who suffered from a severe pneumococcal pneumonia during 1993–97 and were treated in the ICU at our institution. Patients who required mechanical ventilation more than 10 days (n = 18) were selected for the study. Based on empirical data, late steroid therapy was started for 11 patients because of persistent impairment of gas exchange and/or inflammatory process of the lungs, and the remaining 7 patients served as controls. Methylprednisolone was intravenously administered with a daily dose of 80 mg and 40 mg. The dosage was gradually decreased. General treatment of the patient groups was similar including lung protective ventilatory strategies, prone positioning and invasive hemodynamic monitoring The steroid therapy was started within 9.3 days (range, 7–13 days) after hospitalization. Accordingly, the values of the control group were monitored on the day 10 after hospitalization. Mortality was assessed on the day 30.

Results

Age, sex, APACHE II-score and lung injury score, Multi-organ Dysfunction Score (MODS), CRP-level and PaO2/FiO2-ratio were comparable at the start of steroid therapy or day 10. The changes in CRP, MODS and PaO2/FiO2 between the day steroid treatment started (day 0) and 3 days thereafter differed significantly between the two groups.

Conclusions

Although the sample size of this retrospective study was small, our results support the increasing evidence of the advantages of late steroid therapy in acute lung injury.