A systematic review 1 including 9 studies with a total of 1 073 subjects was abstracted in DARE. In preventive use of steroids in critically ill patients (4 studies), there was an 86.6% probability of an OR ≥1, suggesting evidence of an association between steroid therapy and the development of acute respiratory distress syndrome (ARDS; 1.55, 95% CI 0.58 to 4.05). There was also a weakly increased risk of death (72.8% probability of an OR ≥1) associated with steroid use in patients who went on to develop ARDS (OR 1.52, 95% CI 0.30 to 5.94). For studies examining therapeutic use after ARDS onset (5 studies), there was a 6.8% probability of an OR ≥1, suggesting that steroids were associated with a trend towards reduced mortality (OR 0.62, 95% CI 0.23 or 1.26). Steroid therapy was associated with more ventilator-free days (mean difference 4.05 days, 95% CI 0.22 to 8.71).
Comment: The quality of evidence is downgraded by inconsistency (variability in results across studies) and by imprecise results (few patients and wide confidence intervals).
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