Low-Dose Steroid Therapy at an Early Phase of Postoperative Acute Respiratory Distress Syndrome Hyun-Sung Lee, MD, Jong Mog Lee, MD, Moon Soo Kim, MD,

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Low-Dose Steroid Therapy at an Early Phase of Postoperative Acute Respiratory Distress Syndrome Hyun-Sung Lee, MD, Jong Mog Lee, MD, Moon Soo Kim, MD, Hyae Young Kim, MD, PhD, Bin Hwangbo, MD, Jae Ill Zo, MD, PhD The Annals of Thoracic Surgery Volume 79, Issue 2, Pages 405-410 (February 2005) DOI: 10.1016/j.athoracsur.2004.07.079 Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Alteration of arterial oxygenation efficiency (PaO2/FiO2) between conventional therapy (dotted line) and early low-dose steroid therapy (solid line). In early low-dose steroid therapy an increase in the PaO2/FiO2 ratio was observed in 10 patients immediately after starting low-dose methylprednisolone treatment. The mean PaO2/FiO2 ratio, which was 188 ± 67 before treatment, increased to 222 ± 87 on day 4, 266 ± 104 on day 5, and 291 ± 73 on day 6 (p < 0.05), and had also significantly increased between days 3 and 4 and between days 5 and 6 (p < 0.05). The median number of days before tapering methylprednisolone was 4.5 (range, 3 to 10 days), and the median number of days before cessation of methylprednisolone or changing to a single oral dose was 9.5 (range, 5 to 19 days). (ARDS = acute respiratory distress syndrome; immed. = immediate postoperative; POD# = postoperative day number; preop. = preoperative.) The Annals of Thoracic Surgery 2005 79, 405-410DOI: (10.1016/j.athoracsur.2004.07.079) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Chest image findings at the onset and follow-up after recovery in 2 acute respiratory distress syndrome patients from the early low-dose steroid therapy group. (A–C) Chest roentgenogram image and computed tomographic (CT) scans of a 65-year-old man who underwent right lower lobectomy and wedge resection of the left and right upper lobes under bilateral thoracotomies. (A) Chest infiltration was initiated 3 days postoperatively. (B) Acute respiratory distress syndrome was confirmed on day 4 and chest CT was performed. (C) Follow-up chest CT after 1 month revealed complete resolution of chest infiltration. (D–F) Chest roentgenogram image and CT scans of a 67-year-old man who underwent left pneumonectomy for lung cancer. (D) Chest infiltration was initiated 2 days postoperatively. (E) Acute respiratory distress syndrome was confirmed on day 3. (F) Follow-up CT after 1 month revealed complete resolution of chest infiltration. The Annals of Thoracic Surgery 2005 79, 405-410DOI: (10.1016/j.athoracsur.2004.07.079) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions