Comparative Study between the Uses of High Dose Corticosteroid Therapy for Short Duration Versus Low Dose Corticosteroid for Long Duration in Severe Lung Contusion with ARDS

Corticosteroids are used in ARDS to prevent lung fibrosis. The best dose, duration and regimen are still the points of debate among physicians.

The aim of this study is to make a comparison between two corticosteroid regimens, i.e. short-duration high dose versus long- duration low dose corticosteroid use in ARDS due to lung contusion with VAP for lowering both morbidity and mortality rates and early weaning from ventilator.

Patients who had >3 on Murray score and >6 on CPIS were allocated randomly in two groups of 120 patients each. Group A received 30 mg/kg methyl-prednisolone slowly intravenously in 250 ml normal saline every 8 hours for only 48 hours, while group B received 1 mg/kg/day methyl-prednisolone divided into three doses given every 8 hours for two weeks. The study lasted for 16 days; morbidity was considered if no improvement was observed in any or all clinical parameters of both Murray and CPIS scores and if there was failure in removing patients from the ventilator within the studied period.

Significant improvement was observed in patients of group B compared to group A with regard to APACH II <10 score, arterial oxygen saturation>95, hypoxic index >300, lung infiltrate in chest X-ray, lung compliance, response of the lung to recruitment maneuver, the return of core temperature to normal, normal tracheal secretion, the return of leucocytic count to normal, negative qualitative sputum culture and a significantly higher number of patients were removed from the ventilator of group B compared to group A. However, mortality rate was not significant between the two groups.

Low dose corticosteroid if used for a long duration significantly lowers morbidity and accelerates recovery, and in turn, accelerates weaning from ventilator compared to high dose corticosteroid used for a short duration. While the difference between the two regimens was not significant with regard to the mortality rate, still further studies are needed to emphasize a fixed corticosteroid dose and regimen in ARDS due to lung contusion.