[Steroid treatment of shock lung--tune for re-evaluation?]

The acute respiratory distress syndrome (ARDS) is one consequence of the body's systemic inflammatory response to a variety of powerful external stimuli. Glucocorticosteroids are highly effective anti-inflammatory drugs. During the last few years, the molecular mechanisms for their mode of action have been revealed; this has prompted a new wave of interest in corticosteroid treatment of systemic inflammatory states. Several clinical studies have been launched; the results have so far been promising.

We briefly discuss how new knowledge in this field may influence the use of corticosteroids in the treatment of ARDS. The presentation is illustrated by a case study.

The patient was a 15-year-old boy with life-threatening and therapy-resistant ARDS. He was treated in a respirator in an intensive care unit (ICU). Two weeks after admission to the ICU, his situation was desperate. High-dose corticosteroids were instituted, and during a five days' treatment his condition improved dramatically. After discontinuation of glucocorticoids he made further progress and was discharged from the ICU after another eleven days.

In this particular patient, administration of glucocorticoids had a striking effect. The influence of glucocorticoids on the activation of the transcription factor NF-kappa B and a resulting reduced synthesis of a number of key inflammatory molecules may be one explanation for the positive course.