A case of long-term low dose methylprednisolone administration in late phase ARDS

Abstract

A 68-year-old patient who had undergone esophagectomy suffered from ARDS and needed prolonged mechanical ventilation. On postoperative day 19, his arterial blood gases were pH7.30, PaO₂ 68mmHg, PaCO₂ 93mmHg at F_IO₂ 0.95 under PEEP 10cmH₂O, pressure control ventilation (PCV) 15cmH₂O. Since bacterial cultures of bronchoalveolar lavage fluid resulted as negative for two times, we considered the patient was free from bacterial pneumonia. Methylprednisolone (MP) was administered according to Meduri's report. Blood gases improved gradually followimg the administration of MP and the patients was successfully weaned from a ventilator. We presume that MP was effective for this patient. No matter how MP is effective, it suppresses immunity and therefore we should carefully evaluate if infection exists or not. As a conclusion, longterm low-dose MP may be available for the fibroproliferative phase of ARDS so far as infection is excluded.