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Evidence summaries

Corticosteroids for Acute Respiratory Distress Syndrome (Ards) in Adults

Corticosteroids started after the onset of acute respiratory distress syndrome (ARDS) may reduce mortality. Preventive steroids may possibly increase the incidence of ARDS in critically ill adults. Level of evidence: "C"

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 HASH(0x2fcfe80)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 HASH(0x2fcfe80)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 HASH(0x2fcfe80)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).

    References

    • Peter JV, John P, Graham PL, Moran JL, George IA, Bersten A. Corticosteroids in the prevention and treatment of acute respiratory distress syndrome (ARDS) in adults: meta-analysis. BMJ 2008 May 3;336(7651):1006-9 [PubMed] [DARE]

Primary/Secondary Keywords