Experimental data show that
lung injury may be prevented or reduced when
steroids are administered early. It seems, however, difficult to reverse a
lung injury which is already established. Accordingly, we have since 1976 administered high doses of
methylprednisolone already on admission in patients with multiple
rib fractures and/or
flail chest (30 mg/kg i.v. X 3 at 8 hr intervals). A retrospective analysis of 143 patients with severe blunt chest
trauma, most of whom were multitraumatized (72%) and many in
shock (19%) revealed a significantly lower mortality for 44
steroid treated patients compared to 99 nonsteroid patients with similar
injuries (9.1 vs 29.3%, p = 0.02). The incidence of bronchial
infection and
septicemia was not increased in
steroid treated patients. There was also a lower incidence of
multiple organ failure in the
steroid treated group (4.5%) as compared to the control group (9.1%, n.s.). Hemodynamic and blood gas changes were examined in a prospective controlled study including 40 patients with multiple
rib fractures and lung
contusion. Pulmonary vascular resistance (PVR), which is a good parameter of injury severity, was reduced significantly in the
steroid treated group. This led to a reduction in right heart work. The
corticosteroid induced reduction in PVR was seen whether the patient was on a
ventilator or breathed spontaneously. There were no significant differences in the a-v
oxygen difference or in intrapulmonary shunting. Both the number of complications and the duration of
artificial respiration were reduced in the
steroid group.