Chest
Volume 79, Issue 2, February 1981, Pages 133-142
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Clinical Investigations
Alveolo-capillary Permeability in Human Septic ARDS: Effect of High-dose Corticosteroid Therapy

https://doi.org/10.1378/chest.79.2.133Get rights and content

High-dose corticosteroid therapy has been advocated as adjunctive therapy in the adult respiratory distress syndrome (ARDS). We evaluated the effect of pharmacologic doses of corticosteroid (methylprednisolone and dexamethasone) on alveolo-capillary permeability in human septic ARDS by examining the change in appearance of intravenously administered iodine 131 (131I) human serum albumin (I-HSA) into broncho-alveolar secretions, before and after corticosteroid administration. Of 19 patients examined, in 14 (group 1) the clearance of I-HSA was reduced by corticosteroid (pre, .204±.08 ml/hr; post, .096 ±•01 ml/hr; P<.001), while in five (group 2) it ws unaffected (pre, .23±.02 ml/hr; post, .215±.01 ml/hr; P = NS). Group 2 patients were more severely ill than group 1 patients in that their mean intrapulmonary shunt fractions and mean pulmonary artery pressures were higher. We conclude that high-dose corticosteroid therapy may reduce alveolo-capillary permeability in human septic ARDS if used early in the course of the illness.

Section snippets

Materials and Methods

Nineteen patients admitted to the critical care/trauma unit of Victoria Hospital with a diagnosis of ARDS secondary to sepsis were observed. Sepsis was defined as previously1 by the presence of an identifiable focus either at surgery or post mortem examination, together with the presence of a positive culture (blood, urine, sputum, or other), an associated leukocytosis, and febrile response. These patients all had the high systemic flow, low peripheral resistance hemodynamic pattern typical of

Results

Nineteen patients were examined before and after the administration of methylprednisolone, 30 mg/kg (n = 14), or dexamethasone (n = 5). Examination of the measurements of the clearance of I-HSA from blood to BAS allowed separation into two distinct groups: those whose clearance of I-HSA was reduced after the corticosteroid (group 1) and those whose clearance was unaffected by the corticosteroid (group 2).

Discussion

In this study, we have examined the effect of high-dose IV corticosteroid therapy on alveolo-capillary permeability in human septic ARDS by assessing the effect on clearance of I-HSA from blood to bronchoalveolar secretions. We found that IV high-dose corticosteroid therapy reduced the alveolo-capillary permeability defect in most, but not all, cases of ARDS secondary to sepsis, and that the responders to high-dose corticosteroid therapy appeared to be well differentiated from the nonresponders

ACKNOWLEDGMENTS

The authors thank Miss Penny Donaldson, Mr. Bill Ballantyne, Mrs. Azmina Merfani, and the staff of the Critical Care/Trauma Unit for their expert technical assistance in these ongoing projects.

This study was supported in part by the Physicians Services Incoporated Foundation of Ontario and a development research grant from the Upjohn Co. of Canada.

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    Presented in part at the Annual Meeting, Royal College of Physicians and Surgeons of Canada, January, 1978.

    Manuscript received September 10, 1979; revision accepted February 29

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