From the Guidelines
Corticosteroids are beneficial in the treatment of Acute Respiratory Distress Syndrome (ARDS), as suggested by the American Thoracic Society clinical practice guideline 1. The use of corticosteroids in ARDS has been supported by recent evidence, with a conditional recommendation and moderate certainty of evidence 1.
Key Points to Consider
- The American Thoracic Society recommends the use of corticosteroids for patients with ARDS, with a conditional recommendation and moderate certainty of evidence 1.
- Corticosteroids, such as dexamethasone or methylprednisolone, can reduce the inflammatory response and cytokine storm that characterize ARDS, thereby decreasing pulmonary edema and improving lung compliance 1.
- Treatment with corticosteroids should be initiated within the first 14 days of ARDS onset, ideally within the first week, as earlier administration shows greater benefit 1.
- However, corticosteroids should be used cautiously in patients with certain conditions, such as uncontrolled diabetes, active infections (particularly fungal infections), or gastrointestinal bleeding 1.
Important Considerations
- Blood glucose levels should be monitored regularly during treatment with corticosteroids, and prophylaxis for stress ulcers should be considered 1.
- The benefits of corticosteroids in ARDS were particularly highlighted during the COVID-19 pandemic, where they became standard of care for patients requiring oxygen or ventilatory support 1.
Recommendations
- For patients with moderate to severe ARDS, corticosteroids are suggested as a treatment option, with a conditional recommendation and moderate certainty of evidence 1.
- The choice of corticosteroid and dosage should be individualized based on patient characteristics and clinical response 1.
From the Research
Benefits of Steroids in ARDS
- Steroids have been widely used in the management of Acute Respiratory Distress Syndrome (ARDS) due to their biologic rationale 2.
- Studies have shown that corticosteroids can reduce mortality and shorten the duration of mechanical ventilation in patients with ARDS 3, 4.
- A systematic review and meta-analysis found that methylprednisolone had a statistically significant effect on mortality and the time of mechanical ventilation in patients with ARDS, without increasing the risk of adverse events 3.
- Another study found that corticosteroids reduced all-cause mortality, the duration of mechanical ventilation, and increased the number of ventilator-free days in patients with ARDS 4.
Types and Dosages of Steroids
- Different types and dosages of steroids may have varying effects on patients with ARDS 5.
- A network meta-analysis found that low-dose methylprednisolone may be the optimal treatment for ARDS, while high-dose methylprednisolone or no steroid may be inferior treatments 5.
- A randomized controlled trial found that low-dose prolonged methylprednisolone infusion improved lung function and reduced the duration of mechanical ventilation and ICU length of stay in patients with early severe ARDS 6.
Safety and Efficacy of Steroids
- Steroids have been found to be safe and effective in reducing mortality and improving outcomes in patients with ARDS 3, 4, 6.
- However, corticosteroids may increase the risk of hyperglycemia and neuromuscular weakness in patients with ARDS 4.
- Further studies are needed to fully characterize the efficacy and safety of steroids in ARDS and to identify the optimal type and dosage of steroid treatment 3, 5.