From the Guidelines
Corticosteroids are recommended for patients with acute respiratory distress syndrome (ARDS), as they have been shown to reduce mortality, increase ventilator-free days, and shorten ICU stays, according to the most recent guidelines from the American Thoracic Society 1. The use of corticosteroids in ARDS is supported by moderate certainty of evidence, with a conditional recommendation for their use in patients with ARDS 1.
- The typical treatment duration ranges from 7-14 days, with some protocols using a tapering schedule to avoid rebound inflammation.
- Early initiation within the first 14 days of ARDS onset appears most beneficial, with benefits demonstrated in reducing the duration of mechanical ventilation and improving survival 1.
- Steroids work by reducing the excessive inflammatory response in ARDS, decreasing pulmonary edema, and improving lung compliance.
- However, steroids should be used cautiously in patients with certain contraindications such as active fungal infections or gastrointestinal bleeding.
- Blood glucose monitoring is essential during treatment as hyperglycemia is a common side effect. The strongest evidence for steroid use comes from recent guidelines and studies, which demonstrate the benefits of corticosteroids in ARDS, particularly when initiated early in the disease course 1.
From the Research
Steroids and ARDS: An Overview
- The use of steroids in patients with Acute Respiratory Distress Syndrome (ARDS) has been studied extensively, with recent systematic reviews and meta-analyses suggesting that low-dose steroids are effective in the treatment of ARDS 2, 3, 4, 5.
- The type of steroid used may influence the outcomes in patients with ARDS, with low-dose methylprednisolone potentially being an optimal treatment option 2, 4, 5.
- Corticosteroids have been shown to reduce all-cause mortality, shorten the duration of mechanical ventilation, and increase the number of ventilator-free days in patients with ARDS 3.
Efficacy and Safety of Steroids in ARDS
- Methylprednisolone has been found to be safe and effective in reducing mortality and shortening the time of mechanical ventilation in patients with ARDS 5.
- However, the use of methylprednisolone in patients with persistent ARDS has been associated with increased mortality rates when started more than 14 days after the onset of ARDS 6.
- The efficacy and safety of steroids in ARDS may depend on the type and dosage of the steroid, as well as the timing of initiation and duration of therapy 2, 4.
Potential Benefits and Risks of Steroids in ARDS
- The potential benefits of steroids in ARDS include improved mortality, shortened duration of mechanical ventilation, and increased number of ventilator-free days 3, 4, 5.
- The potential risks of steroids in ARDS include increased risk of hyperglycemia, neuromuscular weakness, and infectious complications 3, 6.
- Further studies are needed to fully characterize the efficacy and safety of steroids in ARDS, including the optimal type and dosage of steroid, as well as the timing of initiation and duration of therapy 2, 4, 5.