Late steroid therapy in primary acute lung injury

Objective:To investigate the effect of steroid treatment in the late phase of primary acute lung injury (ALI) with special emphasis on pneumococcal pn eumonia. Design: Retrospective study. Setting: Multidisciplinary intensive care unit (ICU) in a university hospit al. Patients: Of 31 patients with primary ALI requiring mechanical ventilation for more than 10 days, 16 were treated with methylprednisolone and 15 serve d as controls. Measurements and results: Steroid and control groups were comparable regard ing demographic data, APACHE II score, Multiple Organ Dysfunction Score (MO DS), and PaO2/FiO(2)-ratio on admission to ICU. The mean start of steroid t herapy was 9.7 days after establishment of respiratory failure, and values for control patients were registered on day 10. The PaO2/FiO(2) ratio impro ved significantly within 3 days after the start of steroid therapy, and MOD S and C-reactive protein decreased concurrently. No differences in mortalit y, in length of ICU stay, or in length of mechanical ventilation were detec table. In a subgroup analysis, for patients with Streptococcus pneumoniae p neumonia, beneficial change in physiological variables was evident. Conclusions: In patients with primary ALI, steroid therapy, started 10 days after the start of mechanical ventilation, improves gas exchange and is as sociated with a decrease in multiorgan dysfunction.