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A Journal on Surgery

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Minerva Chirurgica 1999 September;54(9):607-26

language: Italian

Indications and controversies regarding the use of corticosteroids to manage respiratory insufficiency in multiple trauma

Conte V., Greco M.


The rational use of corticosteroids in terms of doses, timing and methods of administration, has proved useful in management of the effects of morbidity and mortality in respiratory insufficiency in multiple trauma patients. MPSS (methyl prednisone sodium succinate) is the drug of choice because, compared to other steroids, it penetrates lung tissue more easily (as demonstrated using autoradiographic techniques). The effect of reducing permeability, shown by MPSS, is more marked in the first 6 hours, followed by a progressive diminution. For this reason, it is advisable to administer the drug every 6-8 hours, irrespective of T 1/2 (12-36 h). However, in syndromes of post-traumatic respiratory distress, corticosteroid therapy is only symptomatic, namely it reduces short term mortality, but does not influence the prognosis in the event of persistent microembolism. On the other hand, it is important not to overlook the disadvantages and possible damaging effects linked to the use of corticosteroids in multiple trauma patients. With regard to the use of ''alternative'' type or support treatments to corticosteroids, the lack of markers documented using atraumatic and reliable techniques hinders the development and clinical application of specific and effective antioxidising treatments. However, alongside the perfection of methods of detecting markers, among the antioxidant drugs, a decisive contribution is expected from the LAZAROIDS or 21-AMINOSTEROIDS (synthesis steroids). With powerful scavenger activity and antioxidant properties (twice those of MPSS), the LAZAROIDS can provide more suitable solutions to the complex therapeutic problems of these patients, also because they lack glucocorticoid and mineralcorticoid activity.

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