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Glucocorticoid Treatment in Acute Respiratory Distress Syndrome: Friend or Foe?

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Intensive Care Medicine

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Abstract

In the early phases of acute respiratory distress syndrome (ARDS) the evolution of systemic and pulmonary inflammation during mechanical ventilation determines the physiological progression (resolving or unresolving) and outcome of the disease [1–3]. In order to achieve partial or total resolution of ARDS, an innate or treatment-induced downregulation of systemic inflammation may be required [1]. Glucocorticoids, as end-effectors of the hypothalamic-pituitary-adrenal (HPA) axis, are the most important physiologic inhibitors of inflammation [4] affecting genes involved in stress-related homeostasis [5]. Recent studies have shown that systemic inflammation-induced glucocorticoid receptor resistance and/or insensitivity is an acquired, generalized process central to the pathogenesis of unresolving ARDS that is potentially reversed by quantitatively adequate and prolonged glucocorticoid supplementation [1, 2, 6]. This chapter will review the mechanisms of action of corticosteroids and the results of experimental and clinical studies on the use of corticosteroids in ARDS.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, Ospedlae di Circolo e Fondazione Macchi, Viale Borri 57, 21100, Varese, Italy

    P. Pelosi

  2. Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute Federal University, Rio de Janeiro, Brazil

    P. R. M. Rocco

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  1. P. Pelosi
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  2. P. R. M. Rocco
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Editor information

Editors and Affiliations

  1. Department of Intensive Care Erasme Hospital, Université libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium

    Jean-Louis Vincent MD, PhD, FCCM, FCCP (Head) (Head)

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Pelosi, P., Rocco, P.R.M. (2008). Glucocorticoid Treatment in Acute Respiratory Distress Syndrome: Friend or Foe?. In: Vincent, JL. (eds) Intensive Care Medicine. Springer, New York, NY. https://doi.org/10.1007/978-0-387-77383-4_20

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  • DOI: https://doi.org/10.1007/978-0-387-77383-4_20

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-77382-7

  • Online ISBN: 978-0-387-77383-4

  • eBook Packages: MedicineMedicine (R0)

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