Corticosteroids for Acute Respiratory Distress Syndrome
Corticosteroids for Acute Respiratory Distress Syndrome
National Heart, Lung and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network
N Engl J Med. 2006;354:1671-1684
Does corticosteroid therapy benefit patients with acute respiratory distress syndrome (ARDS)? To study this question, the study authors conducted a randomized clinical trial involving 180 patients in 25 hospitals for 7 years. The main endpoint was hospital mortality at 60 days, which was nearly identical in the 2 groups: 28.6% in the placebo group compared with 29.2% in the treated group. Steroids resulted in a significant increase in mortality rates in patients enrolled more than 2 weeks after the initial diagnosis or ARDS (P = .02).
Intuitively, one would anticipate that the anti-inflammatory action of steroids would be helpful in treating lung injury that accompanies ARDS. However, this report provides no evidence for the benefit of steroids in reducing mortality from ARDS even though steroid use resulted in early respiratory improvement as measured by a reduction in ventilator use and intensive care unit use. Nevertheless, these early beneficial results did not translate into a long-term benefit; furthermore, initiation of steroid therapy more than 2 weeks after the onset of ARDS appears to increase mortality.
Abstract
Efficacy and Safety of Corticosteroids for Persistent Acute Respiratory Distress Syndrome
National Heart, Lung and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network
N Engl J Med. 2006;354:1671-1684
Summary
Does corticosteroid therapy benefit patients with acute respiratory distress syndrome (ARDS)? To study this question, the study authors conducted a randomized clinical trial involving 180 patients in 25 hospitals for 7 years. The main endpoint was hospital mortality at 60 days, which was nearly identical in the 2 groups: 28.6% in the placebo group compared with 29.2% in the treated group. Steroids resulted in a significant increase in mortality rates in patients enrolled more than 2 weeks after the initial diagnosis or ARDS (P = .02).
Viewpoint
Intuitively, one would anticipate that the anti-inflammatory action of steroids would be helpful in treating lung injury that accompanies ARDS. However, this report provides no evidence for the benefit of steroids in reducing mortality from ARDS even though steroid use resulted in early respiratory improvement as measured by a reduction in ventilator use and intensive care unit use. Nevertheless, these early beneficial results did not translate into a long-term benefit; furthermore, initiation of steroid therapy more than 2 weeks after the onset of ARDS appears to increase mortality.
Abstract
