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Korean J Crit Care Med > Volume 24(2); 2009 > Article
Korean Journal of Critical Care Medicine 2009;24(2): 80-86. doi: https://doi.org/10.4266/kjccm.2009.24.2.80
지속성 급성호흡곤란증후군 환자에서 "저용량" 글루코코르티코이드 치료 효과에 대한 예비연구
남해성ㆍ박맹렬ㆍ박소영ㆍ임소연ㆍ김수아ㆍ송재욱ㆍ전경만ㆍ김호중ㆍ권오정ㆍ서지영
성균관대학교 의과대학 내과학교실 삼성서울병원 호흡기내과
A Preliminary Study on the Effect of "Low-dose" Glucocorticoid Therapy for Patients with Persistent Acute Respiratory Distress Syndrome
Hae Seong Nam, Maeng Real Park, So Young Park, So Yeon Lim, Su A Kim, Jae Uk Song, Kyeongman Jeon, Hojoong Kim, O Jung Kwon, Gee Young Suh
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. suhgy@skku.edu
ABSTRACT
BACKGROUND: The role of glucocorticoids for treating persistent acute respiratory distress syndrome (ARDS) is matter of debate. In the previous studies, the side effects of moderate doses of glucocorticoids might have negated positive effects of glucocorticoids. This study aimed at determining the feasibility of administering "low-dose" glucocorticoid to treat the patients who suffer with persistent ARDS. METHODS: We retrospectively reviewed the medical records of twelve patients with ARDS of at least seven days' duration and who were treated with "low-dose" glucocorticoid (starting dose of 1 mg/kg) between June 2007 to December 2008. The patients were divided by whether or not they were successfully weaned from the ventilator after glucocorticoid therapy. The baseline characteristics and physiologic parameters were recorded for up to 7 days after starting glucocorticoid therapy. RESULTS: Five patients (42%) were included in the weaned group. There was no significant difference in the clinical characteristics and the physiologic parameters between the two groups on the day of ARDS. Yet the weaned group had a significantly lower Sequential Organ Failure Assessment (SOFA) score, as compared to that of the failed group [3 (3-6) vs 8 (5-12), p = 0.009)] at start of glucocorticoid treatment. After 3 days of glucocorticoid therapy, there was significant improvement in the PEEP, the PaO2/FIO2 ratio, the PCO2, the SOFA score and the Murray Lung Injury Score of the weaned group, as compared to that of the failed group. There were no major neuromuscular side effects from the therapy. CONCLUSIONS: This study suggests that the "low-dose" glucocorticoid therapy is feasible and that the SOFA score and the physiologic parameters may assist in determining whether or not to initiate and to continue glucocorticoid therapy for the patients who are suffering with persistent ARDS.
Key Words: acute respiratory distress syndrome; "low-dose" glucocorticoid; physiologic parameters; sequential organ failure assessement
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