Source: Adhikari et al. Pharmacologic therapies for adults with acute lung injury and acute respiratory distress syndrome. Cochrane Database Syst Rev. 2004 Oct 18;(4):CD004477.
Weigelt et al. Early steroid therapy for respiratory failure. Archives of surgery (Chicago, Ill : 1960) (1985) vol. 120 (5) pp. 536-40
Bernard et al. High-dose corticosteroids in patients with the adult respiratory distress syndrome. The New England journal of medicine (1987) vol. 317 (25) pp. 1565-70
Efficacy Endpoints: Early mortality
Harm Endpoints: Infection
Narrative: Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS) represent a spectrum of lung injuries commonly encountered in the intensive care unit. The mortality associated with ARDS is as high as 60% in some studies, and most of these patients will require intubation and mechanical ventilation. Lung protective ventilation strategies remain the cornerstone of treatment of ALI and ARDS (see related post). This review examined pharmacologic therapies for the treatment of ALI and ARDS, including early high-dose corticosteroids in two trials randomizing 187 subjects.
Subjects enrolled in the two RCTs looking at early high-dose corticosteroids for 48 hours or less received steroids within seven days of diagnosis of ALI or ARDS. No mortality benefit was observed in these subjects when compared to the placebo group (RR 1.12, 95% CI 0.72 to 1.74). One study (Weigelt 1985) reported infectious complications, recording them in 77% of steroid-treated subjects versus 43% of placebo-treated subjects.
Caveats: The two RCTs, even when combined, are small and concrete conclusions would be premature, thus these data, while they represent the best currently available evidence, should be considered preliminary. In addition both studies were undertaken during the early and mid-1980’s and it is possible that when combined with more advanced supportive care modalities, or lung protective strategies, the intervention may be more effective. In addition, the trials studied different patient populations with one (Bernard 1987) examining patients with ARDS and the other (Weigelt 1985) examining patients with ALI. There was also significant heterogeneity between the two studies (I2 = 50.1%).
Author: Kamal Medlej, MD
Published/Updated: January 30, 2011
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