Use of corticosteroids in acute lung injury and acute respiratory distress syndrome: A systematic review and meta-analysis*

Tang, Benjamin; Craig, Jonathan C.; Eslick, Guy D.; Seppelt, Ian; McLean, Anthony S.

doi:10.1097/ccm.0b013e31819fb507

Cited by 324 publications

(252 citation statements)

References 32 publications

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“…This condition has been termed critical illnessrelated corticosteroid insufficiency (CIRCI) [5,6]. The presence of CIRCI may increase the morbidity and mortality of critically ill patients and predispose to PTSD [6][7][8][9].…”

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confidence: 99%

The “koala stress syndrome” and adrenal responsiveness in the critically ill

Marik

Levitov

2010

Intensive Care Med

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confidence: 99%

The “koala stress syndrome” and adrenal responsiveness in the critically ill

Marik

Levitov

2010

Intensive Care Med

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“…Current evidence suggests that low tidal volume mechanical ventilation is associated with decreased mortality (1), but even with decreased tidal volume, the mortality of ALI/ ARDS remains high (2). Many pharmacologic treatments have been studied, such as corticosteroids, alprostadil, acetylcysteine, surfactant, or pentoxifylline (3,4), but data on these medications are limited and their effectiveness remains controversial.…”

Section: Objectivementioning

confidence: 99%

Effect of Neutrophil Elastase Inhibitor (Sivelestat Sodium) in the Treatment of Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS): A Systematic Review and Meta-Analysis

et al. 2010

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Introduction Sivelestat is neutrophil elastase inhibitor, which is widely used in Japan for the treatment of acute lung injury. However, the clinical efficacy of the medication has not been convincingly demonstrated. Methods We conducted a systematic review and meta-analysis of randomized controlled trials on sivelestat for the treatment of acute lung injury and acute respiratory distress syndrome. Studies were identified using MEDLINE, EMBASE, Cochrane library, conference proceedings, and references of included studies. Authors were contacted if necessary. ICHUSHI, the Japanese database for medical literature and conference proceedings was also used for the search, since many studies on sivelestat were published in Japanese language and not registered in major databases such as MEDLINE. The primary outcome was mortality within 28-30 days after randomization. Relative risks were pooled with the random effect model. Results 8 trials were included in the analysis. There was no difference in mortality within 28-30 days after randomization (relative risk 0.95, 95% confidence interval 0.72 to 1.26). Subgroup analysis conducted only on studies conducted in Japan showed the same result (0.59, 0.28 to 1.28). There was no difference in mechanical ventilation days (standardized mean difference -0.43, -1.12 to 0.27), but sivelestat was associated with a better short term PaO2/FiO2 ratio (0.30, 0.05 to 0.56). Heterogeneity was not significant for the main analysis and funnel plot did not suggest publication bias. Conclusion Sivelestat was not associated with decreased mortality, even when including studies published in Japanese language.

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“…Most of the major studies and systematic review studies on CAP (with acute lung injury) have used the criteria of methylprednisolone 0.5-2.5 mg·kg −1 ·day −1 (or an equivalent dose of other steroids) [5][6][7][8]. Therefore, we defined low-dose corticosteroid use as intravenous infusion of methylprednisolone 0.5-2.5 mg…”

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confidence: 99%

“…The relationships between ageing and morphological changes of the lung have also been investigated radiographically. LEE et al [5] detected age-related increases in the frequency and severity of air trapping on HRCT images of the lung. Air trapping is induced by occlusion or narrowing of the airway.…”

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confidence: 99%

“…Air trapping is induced by occlusion or narrowing of the airway. LEE et al [5] suggested that age-related occlusion or luminal narrowing occurred at the lobular bronchiole level. HANSELL et al [6] showed a clear relationship between the extent of bronchiectasis and CT attenuation values, which suggests that involvement of the small airways is an integral part of bronchiectasis.…”

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confidence: 99%

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