From the Guidelines
Methylprednisolone is the recommended corticosteroid for treating Acute Respiratory Distress Syndrome (ARDS), with a suggested dose of 1 mg/kg/day for early ARDS and 2 mg/kg/day for late persistent ARDS, followed by slow tapering over 13 days. The use of corticosteroids in ARDS has been investigated in several trials, with evidence suggesting that methylprednisolone is associated with a significant reduction in markers of systemic inflammation, reduction in the duration of mechanical ventilation, and probable reduction in hospital mortality 1. A recent individual patient data analysis confirmed the benefits of prolonged methylprednisolone treatment in early and late ARDS, with improved survival and decreased duration of mechanical ventilation 1.
The timing of corticosteroid administration is crucial, with early intervention (within 72 hours of ARDS onset) generally showing better outcomes 1. The American Thoracic Society clinical practice guideline suggests the use of corticosteroids for patients with ARDS, with a conditional recommendation and moderate certainty of evidence 1. Potential side effects of corticosteroid use in ARDS include hyperglycemia, increased risk of infection, gastrointestinal bleeding, and neuromuscular weakness, so patients should be monitored closely during treatment 1.
Key points to consider when using corticosteroids in ARDS include:
- Methylprednisolone is the preferred corticosteroid due to its greater penetration into lung tissue and longer residence time 1
- The dose and duration of corticosteroid treatment should be individualized based on the severity and duration of ARDS 1
- Corticosteroid treatment should be slowly tapered over 13 days to avoid deterioration from a reconstituted inflammatory response 1
- Infection surveillance is recommended to ensure prompt identification and treatment of hospital-acquired infections 1
From the Research
Corticosteroids Used to Treat ARDS
- Methylprednisolone: This corticosteroid has been studied in several trials for its efficacy in treating ARDS. A study published in 2006 2 found that methylprednisolone improved cardiopulmonary physiology, but did not support its routine use for persistent ARDS. However, a systematic review and meta-analysis published in 2021 3 found that methylprednisolone reduced mortality and shortened the time of mechanical ventilation in patients with ARDS.
- Dexamethasone: A multicentre, randomised controlled trial published in 2020 4 found that early administration of dexamethasone reduced the duration of mechanical ventilation and overall mortality in patients with established moderate-to-severe ARDS.
- Hydrocortisone: A systematic review and meta-analysis published in 2022 5 found that hydrocortisone was associated with reduced 28-day mortality in ARDS patients.
Key Findings
- The use of corticosteroids, such as methylprednisolone and dexamethasone, may be beneficial in reducing mortality and improving outcomes in ARDS patients 3, 4, 5.
- However, the efficacy of corticosteroids in ARDS remains controversial, and more research is needed to fully characterize their effects 2, 6.
- The optimal dosage, corticosteroid agent, and treatment duration for ARDS patients are still unclear 5.