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Abstract
Acute lung injury (ALI) & acute respiratory distress syndrome (ARDS) are severe forms of acute respiratory failure in critically ill patients. Patients with ALI & ARDS require invasive ventilatory support using protective lung strategy as early as possible to avoid ventilator induced lung injury caused by high pressures, volumes and FiO2.
ALI & ARDS are characterized by inflammation of lung parenchyma leading to impaired gas exchange with concomitant release of inflammatory mediators causing inflammation, hypoxemia and frequently resulting in multi organ failure.
Corticosteroid therapy has been used in the treatment of ALI & ARDS during late phase (fibroproliferative) to prevent scarring and also in early severe ARDS (low dose methylprednisolone infusion). However, it was always a controversial issue.
The aim of this work was to evaluate the effect of inhaled corticosteroids (budesonide inhalation suspension) on patients with early phase of ALI & ARDS (1st seven days = exudative phase) as regard morbidity , using Murray score (PaO2 /FiO2 , lung quadrant infiltration , PEEP and compliance) and follow up of lung mechanics, and outcome.
This study was conducted on 30 critically ill patients with acute hypoxemic respiratory failure fulfilling the criteria of ALI or ARDS. They were randomized into two groups by the conventional method of randomization. Each group included 15 patients. Group I (control group) received the standard lines of treatment ( low tidal volume strategy plus treatment of the underlying cause). Group II ( nebulized corticosteroid group) received budesonide inhalation suspension in addition to the standard lines of treatment.