ARDS Support Center - ARDS Support, education and information resources

This is a brief update on the global impact achieved by research steroids in ARDS (most sepsis-induced). The randomized trial investigating prolonged low-dose glucocorticoid treatment in ARDS that we published two years ago in Chest (1) has had an impact in medical practice. This trial won a national research award and was one of the most read articles by Pulmonologists in 2007. The 2008 edition of the Washington Manual of Critical Care states that “with the exception of glucocorticoids, no pharmacological therapy has yet been shown to decrease the mortality of ARDS independent of treating the underlying cause”. Both the Washington Manual and the 2008 International Task Force by the American College of Critical Care Medicine recommended our protocol for the treatment of ARDS.(2)

Most importantly a new comprehensive review of the literature and meta-analysis, published in the current issue of Critical Care Medicine (enclosed), concluded that prolonged low-dose glucocorticoid treatment in ARDS is safe and will save one of four treated patients – translating into 50,000 lives saved per year in the United States alone.(3) Click here to read the recently published commentary in Critical Care Medicine.

Moreover, all nine reviewed studies consistently reported that treatment-associated reduction in inflammation was associated with a significant reduction in duration of mechanical ventilation and ICU stay. Overall, treatment achieved a seven-day reduction in duration of ICU stay translating into tens of thousands of dollars saved per patient.

Physicians all around the globe now have a treatment that is safe (when used in combination with secondary prevention),(4) inexpensive ($200 for 1 month treatment), and highly effective. Click here to read the recently published commentary in Critical Care Medicine.

Warmest regards,

G. Umberto Meduri MD
Memphis VA Medical Center
Professor of Medicine

1. Meduri GU, Golden E , Freire AX, et al. Methylprednisolone infusion in early severe ARDS: results of a randomized controlled trial. Chest. 2007; 131: 954-963.
2. Marik PE, Pastores S, Annane D, et al. Clinical practice guidelines for the diagnosis and management of corticosteroid insufficiency in critical illness: Recommendations of an international task force. Crit Care Med. 2008; 36:1937-1949.
3. Tang B, Craig J, Eslick G, et al. Use of corticosteroids in acute lung injury and acute respiratory distress syndrome: a systematic review and meta-analysis. Crit Care Med. 2009; 37:1594-1603.
4. Meduri GU, Marik PE, Annane D. Prolonged glucocorticoid treatment in ARDS: Evidence supporting effectiveness and safety. Crit Care Med. 2009; 39: 1800-1803.

Steroid treatment in ARDS: a critical appraisal of the ARDS network trial and the recent literature>

The objective of this commentary was to compare the design and results of randomized trials investigating prolonged glucocorticoid treatment (≥ 7 days) in patients with ARDS, and review factors affecting response to therapy, including the role of secondary prevention. They concluded that prolonged glucocorticoid treatment substantially and significantly improves meaningful patient-centered outcome variables, and has a distinct survival benefit when initiated before day 14 of ARDS.

Click here to read the recently published commentary in Intensive Care Medicine.

Meduri GU, Marik PE, Chrousos GP et al. Steroid treatment in ARDS: a critical appraisal of the ARDS network trial and the recent literature. Intensive Care Med. 2008; 34:61–69.

Experts Indicate Methylprednisolone May Save One in Six Treated Patients (Approximately 35,000 patients in the U.S. a Year)

The objective of the recently released study was to determine the effects of low-dose prolonged methylprednisolone infusion on lung function in patients with early severe ARDS. Dr. Meduri and the other investigators concluded that Methylprednisolone-induced down-regulation of systemic inflammation was associated with significant improvement in pulmonary and extrapulmonary organ dysfunction and reduction in duration of mechanical ventilation and ICU length of stay.

Click here to read the recently published study in Chest Journal.

Click here to read an editorial from Dr. Djillali Annane on the use of certain steroids in ARDS patients.

Meduri GU, Golden E, Freire AX et al. Methylprednisolone Infusion in Early Severe ARDS - Results of a Randomized Controlled Trial. Chest. 2007; 131:954-963.

Acute Respiratory Distress Syndrome (ARDS)

Education, care, support, and communication for patients, survivors, families, friends, medical personnel, and others affected by and/or interested in ARDS.

Acute Respiratory Distress Syndrome (ARDS) is an acute, severe injury to most or all of both lungs. Patients with ARDS experience severe shortness of breath and often require mechanical ventilation (life support) because of respiratory failure. ARDS is not a specific disease; instead, it is a type of severe, acute lung dysfunction that is associated with a variety of diseases, such as pneumonia, shock, sepsis (a severe infection in the body) and trauma. ARDS can be confused with congestive heart failure, which is another common condition that can also cause acute respiratory distress.

We at the ARDS Support Center (ASC) welcome you to our website. It is our hope that you will find the information, and support you are searching for. To the left you will find links to the different sections of ASC.

Answers to many of your questions can be found in the "Learn About ARDS" section of our website. We are currently working on a search engine that will make finding answers to your questions much easier. Please be patient. If you are unable to find an answer to your question please do not hesitate to contact members of the Support Staff who will help you in any way they can. If you would like to discuss what you are going through with someone else who has had a similar experience please select two of the support staff members who will be able to offer support and understanding.

We received the following letter from the husband of an ARDS patient. He wanted to share this information with others because he felt another family could be helped.

I am writing you because my wife is currently battling ARDS. Your site really helped our family understand ARDS a lot more. For this we are greatly thankful.

My wife's doctors say she has the worst case they have ever seen and had to use a couple of different treatments that we didn't know about. She is on what they call an ECMO. It's not a very common machine that they use. We were able to find some helpful information at the University of Kentucky medical library. I was hoping that you could post the site address for this information on your website to help other families learn of this treatment. The information is from the University of Michigan's website.

The address is:

http://www.med.umich.edu/ecmo

I believe that this information can help other families when dealing with ARDS and the ECMO machine.

Thank you for your time and support.

Sincerely,
Mark Lashley

The brochure "Understanding ARDS" is now online.

SARS (Severe Acute Respiratory Syndrome)

Much about the virus is a mystery. Here’s what’s known.

“What is my risk of catching it?”
Low, so far. In the United States 55 of the 69 victims have been recent visitors to China, Hong Kong, Vietnam or Singapore—the centers of the epidemic. The rest have been family members of those travelers or medical personnel who treated them.

“How can I tell if I’ve got it?”
If you suspect you’ve been exposed and have a fever over 100.4 degrees, difficulty breathing, a dry cough, aches and malaise, call your doctor immediately.

“Is this a brand new disease?”
Apparently so. Researchers believe a mutant member of a virus family that also causes some forms of the common cold causes it.

“How contagious is it?”
Sneezing and coughing, experts say, can pass the virus and it has an incubation period of up to ten days. It may also linger on objects handled by a person with SARS.

“How can I avoid it?”
The surest way is to stay out of the most affected countries. Frequent hand-washing may also help. Though Hong Kong merchants nearly sold out of surgical masks, doctors say these are of limited help if not properly used.
“How is it treated?”
At this point, doctors can only treat the symptoms, not the disease itself. The good news: SARS’s mortality rate is relatively low. If you get it, you have a 96.5 percent chance of surviving.

“Is SARS related to ARDS?”
NO!! There is absolutely no connection between ARDS and SARS. If you are a surviving ARDS patient, you should have absolutely no concern that you are a prime candidate for SARS.

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