Established adult respiratory distress syndrome successfully treated with corticosteroids

In 1990, we described the treatment of established adult respiratory distress syndrome (ARDS) with a sustained course of adrenocortical steroids (ACS). This report updates our experience with an uncontrolled prospective series. Patients with ARDS of more than 3 days' duration were initially given ACS in intravenous dosages of 125 to 250 mg every 6 hours, with tapering every 3 to 4 days. ARDS was present for 3 to 40 days before treatment. The PO2/FIO2 ranged from 45 to 211 (mean, 109) and the injury index from 2 to 4 (mean, 3.25). Nineteen gallium Ga 67 citrate lung scans were obtained in 18 patients. The scans showed diffuse abnormality in all 19 studies, but added no new diagnostic information. We have treated 26 patients, and overall survival was 81% (21/26). When complicating features were present, survival was 64% (9/14). Our uncontrolled, observational experience in treating established ARDS suggests that a sustained course of ACS may improve survival in these severely ill patients.