Fibroproliferative phase of ARDS; Clinical findings and effects of corticosteroids

G. U. Meduri, J. M. Belenchia, R. J. Estes, R. G. Wunderink, M. El Torky, K. V. Leeper

Research output: Contribution to journalArticle

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Abstract

Most patients with adult respiratory distress syndrome (ARDS) survive the initial insult which caused respiratory failure only to succumb later to sepsis caused by nosocomial pneumonia or to pulmonary fibrosis. Clinical criteria and analysis of the tracheal aspirate are notoriously inadequate for establishing a diagnosis of ventilator-associated pneumonia. We implemented a comprehensive diagnostic protocol to determine the cause of sepsis in ARDS patients who had been ventilated for more than three days and who had no bronchoscopic evidence of pneumonia. Nine patients with late ARDS who had fever (89 percent), leukocytosis (89 percent), a new localized infiltrate (78 percent), purulent tracheal secretions (89 percent), low systemic vascular resistance (50 percent), and marked uptake of gallium in the lungs (100 percent) had no source of infection identified. Open-lung biopsy specimens from seven patients showed the fibroproliferative phase of diffuse alveolar damage and confirmed absence of pneumonia. Treatment with prolonged high doses of corticosteroids was associated with a marked and rapid improvement in lung injury score (p<0.003 at five days). Our findings indicate that the fibroproliferative process occurring in the lungs of patients with late ARDS gives rise to clinical manifestations identical to those of pneumonia and is potentially responsive to steroid treatment.

Original languageEnglish (US)
Pages (from-to)943-952
Number of pages10
JournalChest
Volume100
Issue number4
StatePublished - 1991
Externally publishedYes

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Adult Respiratory Distress Syndrome
Adrenal Cortex Hormones
Pneumonia
Lung
Sepsis
Ventilator-Associated Pneumonia
Gallium
Pulmonary Fibrosis
Leukocytosis
Lung Injury
Respiratory Insufficiency
Vascular Resistance
Fever
Steroids
Biopsy
Therapeutics
Infection

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Meduri, G. U., Belenchia, J. M., Estes, R. J., Wunderink, R. G., El Torky, M., & Leeper, K. V. (1991). Fibroproliferative phase of ARDS; Clinical findings and effects of corticosteroids. Chest, 100(4), 943-952.

Fibroproliferative phase of ARDS; Clinical findings and effects of corticosteroids. / Meduri, G. U.; Belenchia, J. M.; Estes, R. J.; Wunderink, R. G.; El Torky, M.; Leeper, K. V.

In: Chest, Vol. 100, No. 4, 1991, p. 943-952.

Research output: Contribution to journalArticle

Meduri, GU, Belenchia, JM, Estes, RJ, Wunderink, RG, El Torky, M & Leeper, KV 1991, 'Fibroproliferative phase of ARDS; Clinical findings and effects of corticosteroids', Chest, vol. 100, no. 4, pp. 943-952.
Meduri GU, Belenchia JM, Estes RJ, Wunderink RG, El Torky M, Leeper KV. Fibroproliferative phase of ARDS; Clinical findings and effects of corticosteroids. Chest. 1991;100(4):943-952.
Meduri, G. U. ; Belenchia, J. M. ; Estes, R. J. ; Wunderink, R. G. ; El Torky, M. ; Leeper, K. V. / Fibroproliferative phase of ARDS; Clinical findings and effects of corticosteroids. In: Chest. 1991 ; Vol. 100, No. 4. pp. 943-952.
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