The effect of methylprednisolone on the pulmonary accumulation of transferrin in the adult respiratory distress syndrome.

Plasma protein accumulation (PPA) was monitored in the lungs of patients with the adult respiratory distress syndrome (ARDS). Transferrin radiolabelled in vivo with indium-113m was used as the plasma protein marker. Ten patients with clinically defined ARDS, exhibiting increased PPA indices (greater than 1.0 X 10(-3) min-1), were given intravenous infusion of methylprednisolone (MP; 30 mg kg-1 over 10 min). The four patients in whom the PPA indices were reduced to below 0.5 X 10(-3) min-1 within 1 h of completion of MP infusion all survived. In the remaining six patients PPA indices remained above 0.5 X 10(-3) min-1 and five of them died. The PPA indices prior to administration of MP were not significantly different in the survivors (n = 5) and non-survivors (n = 5); however, after MP they were significantly lower in the survivors compared with the non-survivors (P less than 0.02). Thus the response to an infusion of MP, monitored as PPA, may provide a predictor of survival in ARDS.