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Review
, 20 (19)

Corticosteroids in Acute Lung Injury: The Dilemma Continues

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Review

Corticosteroids in Acute Lung Injury: The Dilemma Continues

Daniela Mokra et al. Int J Mol Sci.

Abstract

Acute lung injury (ALI) represents a serious heterogenous pulmonary disorder with high mortality. Despite improved understanding of the pathophysiology, the efficacy of standard therapies such as lung-protective mechanical ventilation, prone positioning and administration of neuromuscular blocking agents is limited. Recent studies have shown some benefits of corticosteroids (CS). Prolonged use of CS can shorten duration of mechanical ventilation, duration of hospitalization or improve oxygenation, probably because of a wide spectrum of potentially desired actions including anti-inflammatory, antioxidant, pulmonary vasodilator and anti-oedematous effects. However, the results from experimental vs. clinical studies as well as among the clinical trials are often controversial, probably due to differences in the designs of the trials. Thus, before the use of CS in ARDS can be definitively confirmed or refused, the additional studies should be carried on to determine the most appropriate dosing, timing and choice of CS and to analyse the potential risks of CS administration in various groups of patients with ARDS.

Keywords: acute lung injury; acute respiratory distress syndrome; corticosteroids; inflammation; lung oedema; oxidative stress; sepsis.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Scheme of pathomechanisms of direct and indirect forms of ARDS. Abbreviations: Ang-2: angiopoietin-2, ARDS: acute respiratory distress syndrome, BALF: bronchoalveolar lavage fluid, IL: interleukin, KL-6: Krebs von den Lungen-6, NETs: neutrophil extracellular traps, MODS: multiple organ dysfunction syndrome, PMNs: polymorphonuclears, RAGE: receptor for advanced glycation end-products, SIRS: systemic inflammatory response syndrome, SP-D: surfactant protein D, TNFα: tumour necrosis factor alpha, VEGF: vascular endothelial growth factor, vWF: von Willebrand factor, ↑: increase.

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References

    1. Matthay M.A., Zemans R.L. The acute respiratory distress syndrome: Pathogenesis and treatment. Annu. Rev. Pathol. 2011;6:147–163. doi: 10.1146/annurev-pathol-011110-130158. - DOI - PMC - PubMed
    1. Umbrello M., Formenti P., Bolgiaghi L., Chiumello D. Current Concepts of ARDS: A Narrative Review. Int. J. Mol. Sci. 2016;18:64 doi: 10.3390/ijms18010064. - DOI - PMC - PubMed
    1. Bernard G.R., Artigas A., Brigham K.L., Carlet J., Falke K., Hudson L., Lamy M., LeGall J.R., Morris A., Spragg R., et al. Report of the American-European Consensus conference on acute respiratory distress syndrome: Definitions, mechanisms, relevant outcomes, and clinical trial coordination. J. Crit. Care. 1994;9:72–81. doi: 10.1016/0883-9441(94)90033-7. - DOI - PubMed
    1. Ranieri V.M., Rubenfeld G.D., Thompson B.T., Ferguson N.D., Caldwell E., Fan E., Camporota L., Slutsky A.S., ARDS Definition Task Force Acute respiratory distress syndrome: The Berlin Definition. JAMA. 2012;307:2526–2533. - PubMed
    1. Fioretto J.R., de Carvalho W.B. ARDS definitions in children: One step forward. J. Pediatr. 2014;90:211–212. doi: 10.1016/j.jped.2013.12.004. - DOI - PubMed

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