[Shock lung (ARDS): glucocorticoids?].

Numerous experimental investigations have demonstrated the benefit of glucocorticoids in the initial phase of the shocklung syndrome (ARDS), showing an increasing pulmonary perfusion by blocking the formation of vasoactive substances and a stabilization of endothelial and lysosomal membranes; another effect is to be seen in the inhibition of neutrophilic chemotaxis and pulmonary leukostasis, leading to reduced inflammatory reaction and less severe pulmonary damage. Clinical studies of glucocorticoid therapy in ARDS indicate a higher rate of surviving patients, when they were treated early and with glucocorticoids in a high dosage. The ill-defined condition of ARDS, however, and the use of different dosages in most of the studies limit the comparison of success dependent on those regimes; e.g. the given dosage varies from a single dose of 250 mg. methylprednisolone to several infusions of 30 mg./kg. body weight. According to the pharmacokinetics of glucocorticoids, the desired effects cannot be expected by application of a single and small dosage. To verify the benefit of high-dosage glucocorticoids in ARDS a stronger definition is needed to mark the onset of the syndrome and the start of glucocorticoid treatment. Additionally the dosage regimen should be standardised.