Intervention
Population
Conclusion
Early ARDS
- Methylprednisolone vs. placebo for 24 hours
- 99 patients with ARDS
- No difference in mortality between the groups (60% vs 63%, p=0.74)
- Methylprednisolone vs. placebo for up to 28 days
- 91 patients with severe ARDS across 5 ICUs in the USA
- Methylprednisolone group showed:
- Reduced mechanical ventilation (5 vs 9.5 days, p=0.002) and reduced ICU stay (7 vs. 14.5 days, p=0.007)
- Non-significant trend towards improved hospital mortality
- Confounded by significant differences between trial groups
- Dexamethasone vs. placebo for 10 days
- 277 patients with moderate to severe ARDS from 17 ICUs across Spain
- Steroid group showed:
- Reduced mechanical ventilation (4.8 day difference, p<0.001)
- Decreased 60-day mortality (21% vs. 36%, p=0.005
Late ARDS
- Methylprednisolone vs. placebo for 14 days
- ARDS on ventilator for ≥ 7 days, no improvement in lung injury score
- No difference in mortality between the two groups (12% vs. 62%, p=0.03)
- Steroid group showed improved oxygenation and increased chance of extubation
- Methylprednisolone vs. placebo for 14 days
- ARDS criteria, on ventilator 7–28 days
- No difference in mortality between the two groups (28.6% vs. 29.2%, p=1.0)
- Steroid group had significantly more ventilator-free days (11.2 vs. 6.1, p<0.001)