Corticosteroid and ARDS: Result of meta-analysis
Several articles have been written regarding role of steroids, its advantages or disadvantages in ARDS. Recently John Victor Peter and his group presented their findings in BMJ.
Method: Search of randomized controlled trials from years 1966 to april 2007.
Data extraction: Two investigators independently assessed trials for inclusion and extracted data into standardized forms. Differences were resolved by consensus.
Data synthesis: Nine randomized trials using variable dose and duration of steroids were identified. Preventive steroids (four studies) were associated with a trend to increase both the odds of patient developing ARDS (odds ratio 1.55), and the risk of mortality in those who subsequently developed ARDS (odds ratio 1.52).
- Steroid administration after the onset of ARDS (five studies) was associated with a trend in reduction in mortality (odds ratio .62).
- Steroid increase the number of ventilator free days compared to control (three studies, mean difference 4.05 days, 95% credible interval 0.22 to 8.71).
- Use of steroids was not associated with increase in risk of infection.
Conclusion: Role of use of steroids in ARDS is not clearly established. Preventive use of steroids increase the incidence of ARDS in critically ill patients, whereas use of steroids after the onset of ARDS possibly reduces the mortality and increases the ventilator free days.
Reference: click to get abstract
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; 336:1006-1009.
