ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)

Corticosteroids for treatment of ARDS:

• In a study in 180 pts with ARDS x > 7d on mechanical ventilation and PaO2:FiO2 ratio < 200 randomized to methylprednisolone IV (0.5mg/kg Q6h x 14d then tapering over several weeks) vs. placebo, there was no sig. diff. in 180d all-cause mortality, BUT mortality wa sig. INCREASED in subgroup of pts who were enrolled > 14d after onset of ARDS (44% vs. 12%) (NEJM 354:1671, 2006--JW)
• In a study in 91 pts with severe early ARDS randomized within 72h of intubation to methylprednisolone 1mg/kg IV QD vs. placebo, with tapering of the treatment over 28d, the steroid group ahd sig. reduction in mortality and ICU length-of-stay; at 7d, steroid recipients were sig. more likely to be breathing without assistance (54% vs. 25%)