Efficacy and safety of low-dose corticosteroids for acute respiratory distress syndrome: A systematic review and meta-analysis

Abstract

BACKGROUND: There are confl icting results regarding whether corticosteroids have better effi cacy than placebo in acute respiratory distress syndrome (ARDS) patients. Therefore, we aim to further evaluate the effi cacy and safety of corticosteroids in adult ARDS patients. METHODS:The databases, including Medline, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, were searched from their inception to May 2, 2020. Randomized controlled trials (RCTs) and observational cohort studies were selected to assess the use of corticosteroids in adult ARDS patients. The quality of the results was judged by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The inverse-variance method with random or fixed effects modeling was used to compute pooled odds ratio (OR), standardized mean diff erence (SMD), and their 95% confi dence interval (CI). RESULTS:Eight eligible RCTs and six cohort studies were included. The use of corticosteroids was associated with reduced mortality (OR 0.57, 95% CI 0.43-0.76, I 2 =35.1%, P=0.148) in ARDS patients, and the result was confirmed in the included cohort studies (OR 0.51, 95% CI 0.27-0.95, I 2 =66.7%, P=0.010). The subgroup analysis stratified by the initiation time and duration of corticosteroid use showed that early ARDS and prolonged corticosteroid use had signifi cant survival benefits in the RCTs. The low-dose corticosteroid use was also associated with significantly more ventilator-free days and a reduced rate of new infections in ARDS patients. CONCLUSIONS:The low-dose corticosteroid therapy may be safe and reduce mortality, especially in patients with prolonged treatment and early ARDS.

Antioxidants as Therapeutic Agents in Acute Respiratory Distress Syndrome (ARDS) Treatment—From Mice to Men

“…To date, there is still no appropriate pharmacological treatment regimen available focusing on disease etiology. Intervention is limited to supportive therapy such as lung-protective mechanical ventilation [ 9 ] and possibly extracorporeal membrane oxygenation (ECMO) [ 10 ], prone positioning [ 11 ], positive end-expiratory pressure (PEEP) [ 12 ], recruitment maneuvers (RM) [ 13 ], neuromuscular blockers [ 14 ], and application of systemic corticosteroids [ 15 ]. Although high-end medicine techniques are pursued, mortality is still up to 50–80%; therefore, new approaches should be intensively evaluated.…”