Glucocorticoids for acute respiratory distress syndrome: A systematic review with meta‐analysis and trial sequential analysis

Junhai, Zhen; Hu, Bangchuan; Gong, Sitang; Yan, Jing; Li, Li

doi:10.1111/eci.13496

Cited by 6 publications

(8 citation statements)

References 45 publications

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“…Glucocorticoids have a potent effect and can indirectly play a role by inhibiting the activation of inflammatory processes, including inhibiting the gene transcription of proinflammatory factors, inhibiting the expression of inducible nitric oxide, and promoting the production of interleukin-10 and interleukin-4 [ 25 ]. In addition, glucocorticoids can also improve coagulation and inhibition response, thereby normalizing the ventilation/blood flow ratio [ 26 ]. Based on the abovementioned effects of hormones, they should theoretically significantly improve the oxygenation index in ARDS patients, but the clinical results are inconsistent.…”

Section: Discussionmentioning

confidence: 99%

Meta-Analysis of the Effect of Glucocorticoids on Adult Acute Respiratory Distress Syndrome

Chen

Lin

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objectives. The aim of this study is to investigate the effect of glucocorticoids in adult patients with acute respiratory distress syndrome (ARDS) by meta-analysis. Methods. PubMed, Cochrane Library, Embase, CNKI, Wanfang Database, and Chinese Biomedical literature database were searched. A randomized controlled trial (RCTS) on glucocorticoid therapy in adult patients with ARDS was conducted from the time of database construction to December 2021. The content is about the randomized controlled trial (RCT) of glucocorticoid treatment for adult patients with ARDS, without limiting the dose and course of glucocorticoid treatment. The quality of the included RCTS was evaluated by using the bias risk assessment tool of the Cochrane Collaboration network, and the basic information, clinical features, and target outcomes of the literature were extracted. The effects of glucocorticoids on mortality and oxygenation index (PaO2/FiO2) in adult ARDS patients were evaluated by meta-analysis. Results. A total of 1,441 ARDS patients in 10 RCTs were finally included, including 734 patients in the glucocorticoid treatment group (hormone group) and 707 patients in the conventional treatment group (control group). The 10 studies included have a good overall design and high quality. Compared with controls, glucocorticoid use was significantly associated with a decrease in mortality in adult ARDS patients (relative risk (RR) = 0.73, 95% confidence interval (95% CI) = 0.59–0.90, P = 0.003 ). Analysis showed that glucocorticoids significantly reduced the mortality in ARDS patients treated with medium and low doses of steroids (RR = 0.73, 95% CI = 0.58–0.92, P = 0.007 ). In patients with early administration of steroids, intervention with glucocorticoids was significantly associated with the decreased mortality in adult ARDS patients compared with controls (RR = 0.74, 95% CI 0.56–0.99, P = 0.04 ). Among patients with more than 7 days of hormone therapy, treatment with glucocorticoids was significantly associated with decreased mortality in adult ARDS patients (RR = 0.66, 95% CI = 0.50–0.88, P = 0.005 ) compared with controls. Glucocorticoids tended to improve PaO2/FiO2 in adult ARDS patients compared with controls, but the difference was not statistically significant (weighted mean difference (WMD) = 11.60, 95% = CI = 15.02–38.22, P = 0.39 ). Conclusion. Glucocorticoid therapy can reduce mortality in adult ARDS patients, and the benefit is more pronounced in patients with medium- and low-dose hormone therapy, early hormone administration, and hormone therapy for more than 7 days. However, no improvement in PaO2/FiO2 by glucocorticoid treatment was found, which needs to be confirmed by further studies.

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Section: Discussionmentioning

confidence: 99%

Meta-Analysis of the Effect of Glucocorticoids on Adult Acute Respiratory Distress Syndrome

Chen

Lin

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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“…Moreover, timely inhaled corticosteroids and beta-2 agonists may slow the progression by reducing lung inflammation and enhancing alveolar fluid clearance in ARDS patients (29). Only single-center study and small randomized trial demonstrated a certain effect of different dose of glucocorticoids in ARDS (5,30). In our case, low-dose prednisone acetate played an important role in the treatment of waterproofing spray-related ARDS.…”

Section: Discussionmentioning

confidence: 61%

“…We stopped anti-infective therapy after mNGS test, on account of lacking of etiological evidence. The recommendations from evidence-based medicine point out that a low dose of methylprednisolone 0.5-1 mg/kg body weight/d for mild ARDS (5). The total dosages of methylprednisolone were calculated based on the bodyweight of the patient (54 kg).…”

Section: Case Presentationmentioning

confidence: 99%

“…Timely identification and diagnosis, accurate assessment of disease severity, and early initiation of therapy will improve prognosis (4). Integrated therapeutic strategies of ARDS include treatment of primary disease, prone position ventilation, lung protective ventilation strategy, extracorporeal membrane oxygenation, short-term of neuromuscular blockers and glucocorticoid (3,(5)(6)(7). Prognosis of patients suffering with ARDS depends on the primary diseases, complications, effect of treatment and drug-related adverse reactions.…”

Section: Introductionmentioning

confidence: 99%

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Acute Respiratory Distress Syndrome Caused by Occupational Exposure to Waterproofing Spray: A Case Report and Literature Review

Chen

Cao

et al. 2022

Front. Public Health

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BackgroundAcute respiratory distress syndrome (ARDS) is a serious respiratory disease, caused by severe infection, trauma, shock, inhalation of harmful gases and poisons and presented with acute-onset and high mortality. Timely and accurate identification will be helpful to the treatment and prognosis of ARDS cases. Herein, we report a case of ARDS caused by occupational exposure to waterproofing spray. To our knowledge, inhalation of waterproofing spray is an uncommon cause of ARDS, and what makes our case special is that we ruled out concurrent infections with some pathogens by using metagenomic next-generation sequencing (mNGS) as an auxiliary diagnosis, which presents the most comprehensive etiological examination of similar reports.Case PresentationA previously healthy 25 years old delivery man developed hyperpyrexia, chest tightness, cough and expectoration. The symptoms occurred and gradually exacerbated after exposure to a waterproofing spray. The chest computed tomography (CT) finding showed diffuse ground glass and infiltrative shadows in both lungs. The diagnosis of ARDS related to waterproofing spray was established on the basis of comprehensive differential diagnosis and etiological examination. The patient achieved good curative effect after proper systemic glucocorticoid therapy.ConclusionsThe diagnosis and differential diagnosis of acute respiratory failure for outdoor workers, such as delivery drivers or hikers, should be considered whether toxic aerosol exposure exists from daily contacts. The case can educate the public that more attention should be paid to avoid exposure to these chemicals by aerosols/ingestion mode and some preventive strategies should be taken in occupational environment. The treatment effect of glucocorticoids is significant in ARDS patients with general chemical damage caused by inhaling toxic gases and substances.

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“…Metanalyses in patients with severe sepsis or septic shock have reported a significant reduction in all-cause mortality, reduced incidence of MODS, and reduced duration of mechanical ventilation with ulinastatin and with a combination of thymosin alpha-1 (Tα1) and ulinastatin [9,10]. In patients with ARDS, the use of agents such as steroids [11,12] and ulinastatin [13] has been shown to reduce mortality and duration of mechanical ventilation significantly. Although some reports suggested possible benefits in terms of reduced length of hospital stay, the need for surgical intervention, and the mortality rate with the use of steroid therapy in severe AP [14], the role of steroids in AP is controversial.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Approaches in Modulating the Inflammatory and Immunological Response in Patients With Sepsis, Acute Respiratory Distress Syndrome, and Pancreatitis: An Expert Opinion Review

Mehta¹,

Dixit²,

Zirpe³

et al. 2021

Cureus

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Immunomodulation has long been an adjunct approach in treating critically ill patients with sepsis, acute respiratory distress syndrome (ARDS), and acute pancreatitis (AP). Hyperactive immune response with immunopathogenesis leads to organ dysfunction and alters the clinical outcomes in critically ill. Though the immune response in the critically ill might have been overlooked, it has gathered greater attention during this novel coronavirus disease 2019 (COVID-19) pandemic. Modulating hyperactive immune response, the cytokine storm, especially with steroids, has shown to improve the outcomes in COVID-19 patients. In this review, we find that immune response pathogenesis in critically ill patients with sepsis, ARDS, and AP is nearly similar. The use of immunomodulators such as steroids, broad-spectrum serine protease inhibitors such as ulinastatin, thymosin alpha, intravenous immunoglobulins, and therapies such as CytoSorb and therapeutic plasma exchange may help in improving the clinical outcomes in these conditions. As the experience of the majority of physicians in using such therapeutics may be limited, we provide our expert comments regarding immunomodulation to optimize outcomes in patients with sepsis/septic shock, ARDS, and AP.

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Glucocorticoids for acute respiratory distress syndrome: A systematic review with meta‐analysis and trial sequential analysis

Cited by 6 publications

References 45 publications

Meta-Analysis of the Effect of Glucocorticoids on Adult Acute Respiratory Distress Syndrome

Meta-Analysis of the Effect of Glucocorticoids on Adult Acute Respiratory Distress Syndrome

Acute Respiratory Distress Syndrome Caused by Occupational Exposure to Waterproofing Spray: A Case Report and Literature Review

Therapeutic Approaches in Modulating the Inflammatory and Immunological Response in Patients With Sepsis, Acute Respiratory Distress Syndrome, and Pancreatitis: An Expert Opinion Review

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