Advances in Clinical and Experimental Medicine
2016, vol. 25, nr 6, November-December, p. 1223–1226
Publication type: original article
The Effectiveness of Corticosteroid Usage in Complex Therapy for Severe Sepsis and Acute Respiratory Distress Syndrome in Cases of Severe Traumatic Brain Injury
1 Department of Anesthesiology, Ternopil State Medical University, Ternopil, Ukraine
2 Pope John Paul II State School of Higher Education, Biała Podlaska, Poland
3 Student, Ternopil State Medical University, Ternopil, Ukraine
4 Head of Intensive Care Unit, Ternopil University Hospital, Ternopil, Ukraine
Background. Severe traumatic brain injury (STBI) is an important issue in contemporary medicine and treatment strategies are still in need of improvement. The most dangerous complications of STBI are multiple organ failure and severe sepsis. As many as 80% of STBI patients with multiple organ failure have acute respiratory distress syndrome (ARDS). The need for better treatment strategies for STBI has led to investigations of the positive therapeutic effects of corticosteroids (CS). About 10 to 15 years ago research showed the inexpediency of CS in STBI therapy, but there were also contradictory findings showing their effectiveness. STBI is frequently followed by severe sepsis, which is not usually treated with CS. No scientific papers investigated the usage or non-usage of CS in patients with STBI followed by severe sepsis and ARDS.
Objectives. The aim of the study was to investigate the influence of CS usage on treatment results in patients with STBI followed by severe sepsis and ARDS.
Material and Methods. The study involved an analysis of the treatment results in 267 patients with STBI followed by severe sepsis and ARDS, who were treated with and without CS.
Results. The study showed that patients’ mortality decreased 1.24 times with CS use (500 mg/day of Solu-Medrol® for three days, followed by dose reduction by one-half every 3 days). Patients who took CS survived longer than patients without this treatment. The duration mechanical ventilation was shorter in patients who were treated with CS compared to the other group.
Conclusion. Further research into CS use is needed to improve treatment strategies for STBI followed by severe sepsis and ARDS.
acute respiratory distress syndrome, corticosteroids, severe sepsis, severe traumatic brain injury
- Bullock R: Neurotrauma. Guidelines for the management of severe traumatic brain injury 2007, 24, 101–106.
- Churlyaev А: Acute respiratory distress syndrome with severe traumatic brain injury. Common Resuscitation 2009, 2, 21–27.
- Shekhovtseva K: Epidemiology of traumatic brain injury and the organization of assistance to victims of Stavropol Territory. Dissertation... the candidate of medical sciences: Russian research neurosurgical institute. St. Petersburg, 2006. www.dissercat.com. (Access date: 10.07.2015).
- Saidov S: Violation of hypo coagulating lung function in severe traumatic brain injury. Dissertation. The candidate of medical sciences: Moscow, 2004. www.dissercat.com. (Access date: 10.07.2015).
- Arabi Y, Haddad S, Tamim H: Mortality reduction after implementing a clinical practice guidelines-based management protocol for severe traumatic brain injury. J Crit Care 2010, 25, 190–195.
- Lewandowski K, Lewandowski M: Epidemiology of ARDS. Minerva Anestesiol 2006, 72, 473–477.
- Harman EM: Acute respiratory distress syndrome treatment & management. eMedicineHealth 2014, 2. www// emedicine.medscape.com. (Access date: 10.07.2015).
- Malhotra A: Benefits of low tidal volume ventilation in ARDS. Crit Care Clin 2008, 18, 79–89.
- Luce J: Corticosteroids in ARDS. An evidence-based review. Crit Care Clin 2002, 1, 79–89.
- Meduri G: Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome. A randomized controlled trial. JAMA 2008, 280, 159–165.
- Meduri G: Methylprednisolone infusion in early severe ARDS: Results of a randomized controlled trial. Chest 2007, 131, 954–963.
- Steinberg K: Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med 2007, 354, 1671–1684.
- Meduri G: Steroid treatment in ARDS: A critical appraisal of the ARDS network trial and the recent literature. Intensive Care Medicine 2008, 34, 61–69.
- Izaguirre-Anariba D: Acute respiratory distress syndrome: A complex clinical condition. Medscape 2015. www. reference.medscape.com (Access date: 10.07.2015).
- Roberts I, Yates D, Sandercock P: CRASH trial collaborators. Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): Randomised placebocontrolled trial. Lancet 2008, 364, 1321–1328.
- Martin-Loeches I, Lisboa T, Rhodes A: Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection. Intensive Care Med 2011, 37, 272–283.
- MacLaren R, Jung R: Stress-dose corticosteroid therapy for sepsis and acute lung injury or acute respiratory distress syndrome in critically ill adults. Pharmacotherapy 2002, 22, 1140–1156.
- Agarwal R, Aggarwal A: Etiology and outcomes of pulmonary and extrapulmonary acute lung injury/ARDS in a respiratory ICU in North India. Chest 2006, 130, 724–729.
- Brun-Buisson C, Richard J, Mercat A: Early corticosteroids in severe influenza A/H1N1 pneumonia and acute respiratory distress syndrome. Am J Respir Crit Care Med 2011, 183, 1200–1206.
- Tobias J: Conventional Mechanic Ventilation. Saudi J of Anaesth 2010, 4, 86–98.
- Annane D, Bellissant E, Bollaert P: Corticosteroids for severe sepsis and septic shock: A systematic review and meta-analysis. BMJ 2004, 329, 480.
- Ranieri VM, Rubenfeld GD, Thompson BT: Acute respiratory distress syndrome: The Berlin definition. JAMA 2012, 307, 2526–2533.