Am. J. Respir. Crit. Care Med., Vol 149, No. 2, 02 1994, 306-310.
Acute effect of corticosteroids on respiratory mechanics in mechanically ventilated patients with chronic airflow obstruction and acute respiratory failure
F Rubini, C Rampulla and S Nava
Centro Medico di Riabilitazione di Montescano, Fondazione Clinica del Lavoro, I.R.C.C.S., Italy.
We assessed the short-term effect of steroids on respiratory mechanics in
eight mechanically ventilated patients with chronic airflow obstruction
(CAO) and hypercapnic respiratory failure. Airflow (V), airway pressure
(Paw), and changes in pulmonary volume were measured using a conventional
ventilator. End-expiratory and end-inspiratory airway occlusions were
performed to assess intrinsic PEEP (PEEPi), static compliance of total
respiratory system (Cstrs), maximum inspiratory resistance (Rrsmax), and
minimum inspiratory resistance (Rrsmin). These parameters were recorded at
control, 30 min after saline, and 90 min after steroid (methylprednisolone
0.8 mg/kg intravenous) administration. No significant changes were found in
respiratory mechanics after administration of saline. Steroids induced a
significant decrease (p < 0.01) in inspiratory resistance (Rrsmax from
20.3 +/- 8.6 cm H2O/L/s (control) to 15.3 +/- 6.1 (90 min) and Rrsmin from
16.2 +/- 8.0 (control) to 11.9 +/- 6.5 (90 min), with no significant
reduction in Paw and Cstrs. The PEEPi, reflecting pulmonary dynamic
hyperinflation, was also significantly reduced (-16% from control). We
conclude that in mechanically ventilated CAO patients, steroids may be
useful in improving respiratory mechanics and therefore in providing better
conditions for weaning from mechanical ventilation.
