Steroid Therapy for ARDS, Revisited

A moderate dose, started early and tapered over several weeks, provided benefit.

In a recent clinical trial, moderate-dose corticosteroids were not beneficial for patients with acute respiratory distress syndrome (ARDS; Journal Watch Apr 21 2006). However, a subgroup analysis suggested possible benefit when steroids were started within 7 to 13 days of onset of ARDS (as opposed to starting after day 13). This U.S. trial from Memphis examined outcomes when steroids are started early and given for several weeks.

Ninety-one patients with severe early ARDS were randomized within 72 hours of intubation to receive either IV methylprednisolone (1 mg/kg daily) or placebo. The methylprednisolone dose was tapered over 28 days. By day 7, a lung injury score was significantly lower in the steroid group than in the placebo group, and steroid recipients were more likely to be breathing without assistance (54% vs. 25%). Mortality and length of stay in the ICU were significantly reduced in the steroid group, and an improvement in overall hospital survival just failed to reach statistical significance.

Comment: Steroid therapy for ARDS has been in and out of favor during recent decades. This latest trial suggests that a moderate dose of methylprednisolone, started early and tapered over several weeks, is beneficial. An editorialist (whose recent work indirectly supports the current results; Journal Watch Jan 17 2006) endorses this approach.

— Allan S. Brett, MD

Published in Journal Watch General Medicine April 24, 2007

Citation(s):

Meduri GU et al. Methylprednisolone infusion in early severe ARDS^*: Results of a randomized controlled trial. Chest 2007 Apr; 131:954-63.

·                     Medline abstract (Free)