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Ann Thorac Surg 2005;79:713-715
© 2005 The Society of Thoracic Surgeons

Case report

Surviving Severe Acute Respiratory Distress Syndrome: Utility of Open-Lung Biopsy and Large Doses of Dexamethasone

Kedar S. Deshpande, MD*,a, David W. Appel, MDb, Margarita T. Camacho, MDc, Kathryn E. Tanaka, MDd, Vladimir Kvetan, MDe

a Divisions of Critical Care and Pulmonary Medicine, Department of Medicine, and Bronx, New York, USA
b USA
c Department of Cardiothoracic Surgery, Montefiore Medical Center for the Albert Einstein College of Medicine, Bronx, New York, USA
d Department of Pathology, Montefiore Medical Center for the Albert Einstein College of Medicine, Bronx, New York, USA
e Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New YorkUSA

Accepted for publication July 17, 2003.

* Address reprint requests to Dr Deshpande, Division of Critical Care Medicine, 111 E 210th St, Bronx, NY 10467, USA.
deshpandek{at}aol.com

The etiology of acute respiratory distress syndrome is wide and mortality is extremely high. We describe a patient dying from severe acute respiratory distress syndrome who had a tremendous recovery after receiving dexamethasone (1 g daily). This patient required positive end-expiratory pressure (up to 18 mm/Hg) and fractional inspiratory oxygen (up to 100%). Thirty-six hours after the large dose of corticosteroids, the respiratory mechanics and oxygenation were acceptable for extubation. Acute respiratory distress syndrome was proven and other etiologies of respiratory failure were ruled out by a bedside open-lung biopsy. The biopsy proven acute respiratory distress syndrome dramatically resolved with this salvage therapy. High-dose usage of corticosteroids for acute respiratory distress syndrome has tremendous potential.






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