Low-Dose Methylprednisolone in Transfusion-Related and Trauma-Induced Acute Respiratory Distress Syndrome: An Observational Analytic Investigation

Abstract

Background. Acute respiratory distress syndrome (ARDS) is heterogeneous, and the role of adjunctive corticosteroids varies with etiology, timing, and inflammatory phenotype.

Objective. To describe longitudinal physiological trajectories and corticosteroid responsiveness in two patients with ARDS of different etiologies.

Methods. An observational two-patient case series involved a 14-year-old girl with Marfan syndrome and transfusion-related acute lung injury after scoliosis surgery and a 39-year-old man with pulmonary contusion after blunt thoracic trauma complicated by Acinetobacter baumannii and Enterobacteriaceae pneumonia. Both received individualized lung-protective ventilation and intravenous methylprednisolone 62.5 mg/day. Serial oxygenation, ventilatory mechanics, lactate, and Murray Lung Injury Scores were recorded.

Results. Both patients had a nadir PaO₂/FiO₂ ratio of 72 mmHg. This increased to 343 mmHg by day 5 in Case 1 (+376.4%) and 357 mmHg by day 11 in Case 2 (+395.8%). Murray Lung Injury Scores declined from 3.50 and 3.25 to 0.75 and 0.50, respectively. Case 1 lactate decreased from 5.7 to 1.3 mmol/L (-77.2%). PEEP was reduced, permitting ventilator liberation without reported secondary infection.

Conclusion. The authors conclude that early, phenotype-tailored, low-dose methylprednisolone accelerates alveolar clearance and promotes gas exchange recovery across different ARDS etiologies. This causal interpretation requires author review in the context of the two-case observational design.