Corticosteroids in Acute Lung Injury: The Dilemma Continues

Int J Mol Sci. 2019 Sep 25;20(19):4765. doi: 10.3390/ijms20194765.

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.

Publication types

  • Review

MeSH terms

  • Acute Lung Injury / diagnosis
  • Acute Lung Injury / drug therapy*
  • Acute Lung Injury / epidemiology
  • Acute Lung Injury / etiology
  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / adverse effects
  • Adrenal Cortex Hormones / therapeutic use*
  • Animals
  • Anti-Inflammatory Agents / administration & dosage
  • Anti-Inflammatory Agents / adverse effects
  • Anti-Inflammatory Agents / therapeutic use*
  • Clinical Studies as Topic
  • Disease Management
  • Disease Models, Animal
  • Disease Susceptibility
  • Drug Evaluation, Preclinical
  • Humans
  • Incidence
  • Respiratory Distress Syndrome / diagnosis
  • Respiratory Distress Syndrome / etiology
  • Respiratory Distress Syndrome / therapy
  • Treatment Outcome

Substances

  • Adrenal Cortex Hormones
  • Anti-Inflammatory Agents