Chest
Clinical InvestigationsAlveolo-capillary Permeability in Human Septic ARDS: Effect of High-dose Corticosteroid Therapy
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.
References (49)
- et al.
Pulmonary hypertension in sepsis
Chest
(1978) - et al.
Thermal dilution cardiac output determinations with the use of a flow directed balloon tipped catheter
Am Heart J
(1972) - et al.
Preparation of chronic lung lymph fistules in sheep
J Surg Res
(1975) - et al.
The value of edema fluid protein measurements in patients with pulmonary edema
Am J Med
(1979) - et al.
Uremic pulmonary edema
Am J Med
(1978) Pulmonary abnormalities in sepsis
S.C.N.A.
(1974)Methylprednisolone: pharmacologic doses in shock lung syndrome
J Thorac Cardiovasc Surg
(1976)- et al.
Physiologic shunting in the lung in critically ill or injured patients
J Surg Res
(1970) - et al.
The effect of steroids on adaptation to atelectatic shunting
J Thorac Cardiovasc Surg
(1974) - et al.
Documentation of pulmonary capillary permeability in the adult respiratory distress syndrome accompanying human sepsis
Am Rev Respir Dis
(1979)
Pulmonary edema: evidence for increased pulmonary capillary permeability
Am Rev Respir Dis
Increased sheep lung vascular permeability caused by Pseudomonas bacteremia
J Clin Invest
The effects of endogenous and exogenous histamine on pulmonary alveolar membrane permeability
Am Rev Respir Dis
Effect of increased vascular pressure on lung fluid balance in unanaesthetized sheep
Circ Res
Pathogenesis of pulmonary edema associated with the adult respiratory distress syndrome
Can Med Assoc J
Continuous positive pressure ventilation in acute respiratory failure
N Engl J Med
Pulmonary effects of albumin resuscitation for severe hypovolemic shock
Arch Surg
Crystalloid vs colloid resuscitation: is one better?
Surgery
Respiratory function of blood in the acutely ill patient and the effect of steroids
Ann Surg
Cardiopulmonary adjustments following single high dose administration of methylprednisolone in traumatized man
Ann Surg
Effects of methylprednisolone on pulmonary microcirculation
Surg Gynecol & Obstet
Methylprednisolone prevents endotoxin induced high lung vascular permeability in the awake sheep (abstr)
Clin Res
Patterns of septic shock in man-a detailed study of 56 patients
Ann Surg
Protein composition of lung fluids in anesthetized dogs with acute cardiogenic edema
Am J Physiol
Cited by (80)
Acute lung injury complicating acute kidney injury: A model of endogenous αKlotho deficiency and distant organ dysfunction
2017, BoneCitation Excerpt :Pulmonary dysfunction develops frequently and to different degrees in clinical and experimental AKI; this under-appreciated complication of AKI could potentially culminate in the acute respiratory distress syndrome (ARDS) [58–62]. Typical clinical manifestations of incipient ARDS include decreased lung diffusing capacity, forced vital capacity and maximal ventilation [66], overt inflammation [67,68], increased alveolar-capillary permeability [69,70], leading to low-pressure alveolar edema arterial hypoxemia and impaired carbon dioxide excretion [71]. Severe pulmonary dysfunction requiring ventilator support in the setting of AKI increases mortality from 29% to 81% even after multivariate adjustment [72].
Steroids for acute respiratory distress syndrome?
2014, Clinics in Chest MedicineCitation Excerpt :In the 1970s, many clinical and animal studies showed beneficial effects of corticosteroids on intermediate physiologic outcomes in the setting of sepsis and ARDS. Steroids were shown to reduce inflammation by decreasing complement activation16 and neutrophil aggregation,17 and were found to have potentially advantageous effects on oxyhemoglobin dissociation,18 cardiac output,19 pulmonary vascular pressure,20 and alveolocapillary permeability.21 In combination with case reports describing improved outcomes of patients with sepsis and ARDS after receipt of steroids, there was enough evidence to spur randomized clinical trials.
Plasma DNA, prediction and post-traumatic complications
2001, Clinica Chimica ActaDerivation of a prediction rule for post-traumatic acute lung injury
1999, ResuscitationVentilation in the trauma and surgical patient
1998, Critical Care ClinicsPharmacologic adjuncts to mechanical ventilation in acute respiratory distress syndrome
1998, Critical Care Clinics
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