High-dose corticosteroids in thoracic trauma.

Abstract

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.

• Authors: J L Svennevig, B Bugge-Asperheim, O Geiran, J Vaage, J Pillgram-Larsen, N B Fjeld, S Birkeland
• Journal: Acta chirurgica Scandinavica. Supplementum (Acta Chir Scand Suppl) Vol. 526 Pg. 110-9 ( 1985) ISSN: 0301-1860 [Print] Sweden
• PMID: 3867204 (Publication Type: Journal Article)

Chemical References

• Oxygen
• Methylprednisolone

Topics

• Female
• Flail Chest (complications)
• Hemodynamics (drug effects)
• Humans
• Lung Injury
• Male
• Methylprednisolone (therapeutic use)
• Multiple Organ Failure
• Oxygen (blood)
• Prospective Studies
• Pulmonary Artery (drug effects)
• Retrospective Studies
• Rib Fractures (complications)
• Shock, Traumatic (drug therapy, etiology, prevention & control)
• Thoracic Injuries (complications)
• Vascular Resistance (drug effects)