Steroids in early ARDS?

Aldabbagh, Tarek; Milbrandt, Eric B; Linden, Peter K.

doi:10.1186/cc5908

Cited by 5 publications

(4 citation statements)

References 13 publications

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“…These pharmacological approaches may be beneficial, but as yet there is no definitive treatment for ARDS 13–17. Regarding the use of corticosteroids, this has been investigated in various studies 14–16. A study of low-dose corticosteroids in late ARDS did not support the routine use of corticosteroids for persistent ARDS despite improvements in cardiopulmonary physiology, and starting therapy more than 2 weeks after the onset of ARDS was found to be possibly associated with an increase in the risk of death 15.…”

Section: Diagnosis and Treatment Of Ardsmentioning

confidence: 99%

“… 13 – 17 Regarding the use of corticosteroids, this has been investigated in various studies. 14 – 16 A study of low-dose corticosteroids in late ARDS did not support the routine use of corticosteroids for persistent ARDS despite improvements in cardiopulmonary physiology, and starting therapy more than 2 weeks after the onset of ARDS was found to be possibly associated with an increase in the risk of death. 15 Low doses of corticosteroids were associated with better outcomes in septic shock-associated early ARDS in nonresponders to the short cosyntropin stimulation test, but not in responders and not in patients with septic shock without ARDS.…”

Section: Diagnosis and Treatment Of Ardsmentioning

confidence: 99%

“… 15 Low doses of corticosteroids were associated with better outcomes in septic shock-associated early ARDS in nonresponders to the short cosyntropin stimulation test, but not in responders and not in patients with septic shock without ARDS. 16 …”

Section: Diagnosis and Treatment Of Ardsmentioning

confidence: 99%

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Clinical utility of the neutrophil elastase inhibitor sivelestat for the treatment of acute respiratory distress syndrome

Aikawa¹,

Kawasaki²

2014

TCRM

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Acute respiratory distress syndrome is a serious condition that can arise following direct or indirect lung injury. It is heterogeneous and has a high mortality rate. Supportive care is the mainstay of treatment and there is no definitive pharmacological treatment as yet. Sivelestat is a neutrophil elastase inhibitor approved in Japan and the Republic of Korea for acute lung injury, including acute respiratory distress syndrome in patients with systemic inflammatory response syndrome. The aim of this review is to examine the clinical utility of sivelestat in different disease states, using data from nonclinical and clinical studies. In nonclinical studies, sivelestat appears to show benefit in acute lung injury without inhibiting the host immune defense in cases of infection. Clinical studies do not yet provide a clear consensus. Phase III and IV Japanese studies have shown improvements in pulmonary function, length of intensive care unit stay, and mechanical ventilation, but a non-Japanese multicenter study did not demonstrate sivelestat to have an effect on ventilator-free days or 28-day all-cause mortality. Evidence of improvement in various parameters, including duration of stay in intensive care, mechanical ventilation, the ratio of partial pressure of arterial oxygen and fraction of inspired oxygen (PaO2/FIO2 ratio) ratio, and lung injury scores, has been shown in patients with sepsis or gastric aspiration, and following the surgical treatment of esophageal cancer. To date, there are no particular concerns regarding adverse events, and the available data do not suggest that sivelestat might worsen infections. One study has analyzed cost-effectiveness, finding that sivelestat may reduce costs compared with standard care. The currently available evidence suggests that sivelestat may show some benefit in the treatment of acute lung injury/acute respiratory distress syndrome, although large, randomized controlled trials are needed in specific pathophysiological conditions to explore these potential benefits.

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Section: Diagnosis and Treatment Of Ardsmentioning

confidence: 99%

Section: Diagnosis and Treatment Of Ardsmentioning

confidence: 99%

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Clinical utility of the neutrophil elastase inhibitor sivelestat for the treatment of acute respiratory distress syndrome

Aikawa¹,

Kawasaki²

2014

TCRM

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“…Tag untersucht. Die Patienten erhielten initial 2 mg/kgKG Methylprednisolon und sodann 2 mg/kgKG am Tag für die Tage [3,22,32,48] kommt, neben den teils deutlich kontroversen Beurteilungen der Datenlage, auch v. a. der Mangel an kontrollierten, prospektiven Studien an einer großen Patientenzahl unter den zeitgemäßen Bedingungen der Intensivtherapie zum Ausdruck. Die Bedeutung klinischer Studien, v. a. großer Multizenterstudien, wird im Übrigen auch an erster Stelle in den "Future Research Directions in Acute Lung Injury" des NIH erwähnt [24].…”

Section: Prospektive Kontrollierte Studienunclassified

Kortikosteroidgabe beim schweren akuten Lungenversagen

Möhnle¹,

Briegel²

2012

Anaesthesist

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Despite a number of clinical trials there is still controversy about the role of corticosteroid therapy in acute respiratory distress syndrome (ARDS). In addition recent meta-analyses differed markedly in the conclusions. This review is intended to provide a short practical guide for the clinician. Based on the available literature, high-dose and pre-emptive administration of corticosteroids is hazardous and not indicated. A low-dose corticosteroid regime given for 4 weeks may potentially be helpful and can be considered in acute or unresolved ARDS in less than 14 days after onset of ARDS, if a close infection surveillance program is available, if neuromuscular blockade can be avoided and if a stepwise dose reduction of corticosteroids is performed. The total daily dose at the beginning of treatment should not exceed 2 mg/kg body weight (BW) methylprednisolone.

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