Skip to main content
Erschienen in: Intensive Care Medicine 5/2016

27.10.2015 | Systematic Review

Prolonged glucocorticoid treatment is associated with improved ARDS outcomes: analysis of individual patients’ data from four randomized trials and trial-level meta-analysis of the updated literature

verfasst von: G. Umberto Meduri, Lisa Bridges, Mei-Chiung Shih, Paul E. Marik, Reed A. C. Siemieniuk, Mehmet Kocak

Erschienen in: Intensive Care Medicine | Ausgabe 5/2016

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To investigate the effect of prolonged glucocorticoid treatment for patients with acute respiratory distress syndrome (ARDS).

Methods

We conducted two sets of intention-to-treat analyses: (1) a primary analysis of individual patients’ data (IPD) of four randomized controlled trials (RCTs) which investigated methylprednisolone treatment (n = 322) and (2) a trial-level meta-analysis incorporating four additional RCTs which investigated hydrocortisone treatment in early ARDS (n = 297). We standardized definitions to derive outcomes in all datasets. The primary outcome for the IPD analysis was time to achieving unassisted breathing (UAB) by study day 28. Secondary outcomes included mechanical ventilation (MV) and intensive care unit (ICU)-free days, hospital mortality, and time to hospital mortality by day 28.

Results

By study day 28, compared to the placebo group, the methylprednisolone group had fewer patients who died before achieving UAB (12 vs. 29 %; p < 0.001) and more patients who achieved UAB (80 vs. 50 %; p < 0.001). In the methylprednisolone group, time to achieving UAB was shorter [hazard ratio 2.59, 95 % confidence interval (CI) 1.95–3.43; p < 0.001], and hospital mortality was decreased (20 vs. 33 %; p = 0.006), leading to increased MV (13.3 ± 11.8 vs. 7.6 ± 5.7; p < 0.001) and ICU-free days (10.8 ± 0.71 vs. 6.4 ± 0.85; p < 0.001). In those patients randomized before day 14 of ARDS onset, the trial-level meta-analysis indicated decreased hospital mortality (36 vs. 49 %; risk ratio 0.76, 95 % CI 0.59–0.98, I 2 = 17 %, p = 0.035; moderate certainty). Treatment was not associated with increased risk for infections (risk ratio 0.77, 95 % CI 0.56–1.08, I 2 = 26 %; p = 0.13; moderate certainty).

Conclusions

Prolonged methylprednisolone treatment accelerates the resolution of ARDS, improving a broad spectrum of interrelated clinical outcomes and decreasing hospital mortality and healthcare utilization.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Meduri GU, Annane D, Chrousos GP, Marik PE, Sinclair SE (2009) Activation and regulation of systemic inflammation in ARDS: rationale for prolonged glucocorticoid therapy. Chest 136:1631–1643CrossRefPubMed Meduri GU, Annane D, Chrousos GP, Marik PE, Sinclair SE (2009) Activation and regulation of systemic inflammation in ARDS: rationale for prolonged glucocorticoid therapy. Chest 136:1631–1643CrossRefPubMed
2.
Zurück zum Zitat Meduri GU, Eltorky MA (2015) Understanding ARDS-associated fibroproliferation. Intensive Care Med 41:517–520CrossRefPubMed Meduri GU, Eltorky MA (2015) Understanding ARDS-associated fibroproliferation. Intensive Care Med 41:517–520CrossRefPubMed
3.
Zurück zum Zitat Force ADT, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS (2012) Acute respiratory distress syndrome: the Berlin definition. JAMA 307:2526–2533 Force ADT, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS (2012) Acute respiratory distress syndrome: the Berlin definition. JAMA 307:2526–2533
4.
Zurück zum Zitat Lamontagne F, Briel M, Guyatt GH, Cook DJ, Bhatnagar N, Meade M (2010) Corticosteroid therapy for acute lung injury, acute respiratory distress syndrome, and severe pneumonia: a meta-analysis of randomized controlled trials. J Crit Care 25:420–435CrossRefPubMed Lamontagne F, Briel M, Guyatt GH, Cook DJ, Bhatnagar N, Meade M (2010) Corticosteroid therapy for acute lung injury, acute respiratory distress syndrome, and severe pneumonia: a meta-analysis of randomized controlled trials. J Crit Care 25:420–435CrossRefPubMed
5.
Zurück zum Zitat Reade MC, Delaney A, Bailey MJ, Harrison DA, Yealy DM, Jones PG, Rowan KM, Bellomo R, Angus DC (2010) Prospective meta-analysis using individual patient data in intensive care medicine. Intensive Care Med 36:11–21CrossRefPubMed Reade MC, Delaney A, Bailey MJ, Harrison DA, Yealy DM, Jones PG, Rowan KM, Bellomo R, Angus DC (2010) Prospective meta-analysis using individual patient data in intensive care medicine. Intensive Care Med 36:11–21CrossRefPubMed
6.
Zurück zum Zitat Meduri GU, Golden E, Freire AX, Taylor E, Zaman M, Carson SJ, Gibson M, Umbergere R (2007) Methylprednisolone infusion in early severe ARDS: results of a randomized controlled trial. Chest 131:954–963CrossRefPubMed Meduri GU, Golden E, Freire AX, Taylor E, Zaman M, Carson SJ, Gibson M, Umbergere R (2007) Methylprednisolone infusion in early severe ARDS: results of a randomized controlled trial. Chest 131:954–963CrossRefPubMed
7.
Zurück zum Zitat Rezk N, Ibrahim A (2013) Effects of methylprednisolone in early ARDS. Egypt J Chest Dis Tuberc 62:167–172CrossRef Rezk N, Ibrahim A (2013) Effects of methylprednisolone in early ARDS. Egypt J Chest Dis Tuberc 62:167–172CrossRef
8.
Zurück zum Zitat Meduri GU, Headley S, Golden E, Carson S, Umberger R, Kelso T, Tolley E (1998) Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome. A randomized control trial. JAMA 280:159–165CrossRefPubMed Meduri GU, Headley S, Golden E, Carson S, Umberger R, Kelso T, Tolley E (1998) Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome. A randomized control trial. JAMA 280:159–165CrossRefPubMed
9.
Zurück zum Zitat Steinberg KP, Hudson LD, Goodman RB, Hough CL, Lanken PN, Hyzy R, Thompson BT, Ancukiewicz M (2006) Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med 354:1671–1684CrossRefPubMed Steinberg KP, Hudson LD, Goodman RB, Hough CL, Lanken PN, Hyzy R, Thompson BT, Ancukiewicz M (2006) Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med 354:1671–1684CrossRefPubMed
10.
Zurück zum Zitat Meduri GU, Marik PE, Chrousos GP, Pastores SM, Arlt W, Beishuizen A, Bokhari F, Zaloga G, Annane D (2008) Steroid treatment in ARDS: a critical appraisal of the ARDS network trial and the recent literature. Intensive Care Med 34:61–69CrossRefPubMed Meduri GU, Marik PE, Chrousos GP, Pastores SM, Arlt W, Beishuizen A, Bokhari F, Zaloga G, Annane D (2008) Steroid treatment in ARDS: a critical appraisal of the ARDS network trial and the recent literature. Intensive Care Med 34:61–69CrossRefPubMed
11.
Zurück zum Zitat Confalonieri M, Urbino R, Potena A, Piattella M, Parigi P, Puccio G, Della Porta R, Giorgio C, Blasi F, Umberger R, Meduri GU (2005) Hydrocortisone infusion for severe community-acquired pneumonia: a preliminary randomized study. Am J Respir Crit Care Med 171:242–248CrossRefPubMed Confalonieri M, Urbino R, Potena A, Piattella M, Parigi P, Puccio G, Della Porta R, Giorgio C, Blasi F, Umberger R, Meduri GU (2005) Hydrocortisone infusion for severe community-acquired pneumonia: a preliminary randomized study. Am J Respir Crit Care Med 171:242–248CrossRefPubMed
12.
Zurück zum Zitat Annane D, Sébille V, Bellissant E; Ger-Inf-05 Study Group (2006) Effect of low doses of corticosteroids in septic shock patients with or without early acute respiratory distress syndrome. Crit Care Med 34(1):22–30CrossRefPubMed Annane D, Sébille V, Bellissant E; Ger-Inf-05 Study Group (2006) Effect of low doses of corticosteroids in septic shock patients with or without early acute respiratory distress syndrome. Crit Care Med 34(1):22–30CrossRefPubMed
13.
Zurück zum Zitat Sabry NA, Omar EE-D (2011) Corticosteroids and ICU course of community acquired pneumonia in Egyptian settings. Pharmacol Pharm 2:73–81CrossRef Sabry NA, Omar EE-D (2011) Corticosteroids and ICU course of community acquired pneumonia in Egyptian settings. Pharmacol Pharm 2:73–81CrossRef
14.
Zurück zum Zitat Liu L, Li J, Huang YZ, Liu SQ, Yang CS, Guo FM, Qiu HB, Yang Y (2012) The effect of stress dose glucocorticoid on patients with acute respiratory distress syndrome combined with critical illness-related corticosteroid insufficiency. Zhonghua nei ke za zhi 51:599–603PubMed Liu L, Li J, Huang YZ, Liu SQ, Yang CS, Guo FM, Qiu HB, Yang Y (2012) The effect of stress dose glucocorticoid on patients with acute respiratory distress syndrome combined with critical illness-related corticosteroid insufficiency. Zhonghua nei ke za zhi 51:599–603PubMed
15.
Zurück zum Zitat Vincent JL, de Mendonca A, Cantraine F, Moreno R, Takala J, Suter PM, Sprung CL, Colardyn F, Blecher S (1998) Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med 26:1793–1800CrossRefPubMed Vincent JL, de Mendonca A, Cantraine F, Moreno R, Takala J, Suter PM, Sprung CL, Colardyn F, Blecher S (1998) Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med 26:1793–1800CrossRefPubMed
17.
Zurück zum Zitat Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schunemann HJ (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336:924–926CrossRefPubMedPubMedCentral Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schunemann HJ (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336:924–926CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Gray J (1998) A class of K-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat 16:1141–1154CrossRef Gray J (1998) A class of K-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat 16:1141–1154CrossRef
19.
Zurück zum Zitat Fine JP, Gray RJ (1999) A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 94:496–509CrossRef Fine JP, Gray RJ (1999) A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 94:496–509CrossRef
20.
Zurück zum Zitat Therneau T (2000) Modeling survival data: extending the Cox model. Springer, New YorkCrossRef Therneau T (2000) Modeling survival data: extending the Cox model. Springer, New YorkCrossRef
21.
Zurück zum Zitat Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535CrossRef Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535CrossRef
22.
Zurück zum Zitat Tang B, Craig J, Eslick G, Seppelt I, McLean A (2009) Use of corticosteroids in acute lung injury and acute respiratory distress syndrome: a systematic review and meta-analysis. Crit Care Med 37:1594–1603CrossRefPubMed Tang B, Craig J, Eslick G, Seppelt I, McLean A (2009) Use of corticosteroids in acute lung injury and acute respiratory distress syndrome: a systematic review and meta-analysis. Crit Care Med 37:1594–1603CrossRefPubMed
23.
Zurück zum Zitat Bassler D, Briel M, Montori VM, Lane M, Glasziou P, Zhou Q, Heels-Ansdell D, Walter SD, Guyatt GH, Group S-S, Flynn DN, Elamin MB, Murad MH, Abu Elnour NO, Lampropulos JF, Sood A, Mullan RJ, Erwin PJ, Bankhead CR, Perera R, Ruiz Culebro C, You JJ, Mulla SM, Kaur J, Nerenberg KA, Schunemann H, Cook DJ, Lutz K, Ribic CM, Vale N, Malaga G, Akl EA, Ferreira-Gonzalez I, Alonso-Coello P, Urrutia G, Kunz R, Bucher HC, Nordmann AJ, Raatz H, da Silva SA, Tuche F, Strahm B, Djulbegovic B, Adhikari NK, Mills EJ, Gwadry-Sridhar F, Kirpalani H, Soares HP, Karanicolas PJ, Burns KE, Vandvik PO, Coto-Yglesias F, Chrispim PP, Ramsay T (2010) Stopping randomized trials early for benefit and estimation of treatment effects: systematic review and meta-regression analysis. JAMA 303:1180–1187CrossRefPubMed Bassler D, Briel M, Montori VM, Lane M, Glasziou P, Zhou Q, Heels-Ansdell D, Walter SD, Guyatt GH, Group S-S, Flynn DN, Elamin MB, Murad MH, Abu Elnour NO, Lampropulos JF, Sood A, Mullan RJ, Erwin PJ, Bankhead CR, Perera R, Ruiz Culebro C, You JJ, Mulla SM, Kaur J, Nerenberg KA, Schunemann H, Cook DJ, Lutz K, Ribic CM, Vale N, Malaga G, Akl EA, Ferreira-Gonzalez I, Alonso-Coello P, Urrutia G, Kunz R, Bucher HC, Nordmann AJ, Raatz H, da Silva SA, Tuche F, Strahm B, Djulbegovic B, Adhikari NK, Mills EJ, Gwadry-Sridhar F, Kirpalani H, Soares HP, Karanicolas PJ, Burns KE, Vandvik PO, Coto-Yglesias F, Chrispim PP, Ramsay T (2010) Stopping randomized trials early for benefit and estimation of treatment effects: systematic review and meta-regression analysis. JAMA 303:1180–1187CrossRefPubMed
24.
Zurück zum Zitat Kellum JA, Kong L, Fink MP, Weissfeld LA, Yealy DM, Pinsky MR, Fine J, Krichevsky A, Delude RL, Angus DC (2007) Understanding the inflammatory cytokine response in pneumonia and sepsis: results of the Genetic and Inflammatory Markers of Sepsis (GenIMS) Study. Arch Intern Med 167:1655–1663CrossRefPubMedPubMedCentral Kellum JA, Kong L, Fink MP, Weissfeld LA, Yealy DM, Pinsky MR, Fine J, Krichevsky A, Delude RL, Angus DC (2007) Understanding the inflammatory cytokine response in pneumonia and sepsis: results of the Genetic and Inflammatory Markers of Sepsis (GenIMS) Study. Arch Intern Med 167:1655–1663CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Meduri GU, Headley S, Kohler G, Stentz F, Tolley E, Umberger R, Leeper K (1995) Persistent elevation of inflammatory cytokines predicts a poor outcome in ARDS. Plasma IL-1 beta and IL-6 levels are consistent and efficient predictors of outcome over time. Chest 107:1062–1073CrossRefPubMed Meduri GU, Headley S, Kohler G, Stentz F, Tolley E, Umberger R, Leeper K (1995) Persistent elevation of inflammatory cytokines predicts a poor outcome in ARDS. Plasma IL-1 beta and IL-6 levels are consistent and efficient predictors of outcome over time. Chest 107:1062–1073CrossRefPubMed
26.
Zurück zum Zitat Meduri GU, Kohler G, Headley S, Tolley E, Stentz F, Postlethwaite A (1995) Inflammatory cytokines in the BAL of patients with ARDS. Persistent elevation over time predicts poor outcome. Chest 108:1303–1314CrossRefPubMed Meduri GU, Kohler G, Headley S, Tolley E, Stentz F, Postlethwaite A (1995) Inflammatory cytokines in the BAL of patients with ARDS. Persistent elevation over time predicts poor outcome. Chest 108:1303–1314CrossRefPubMed
27.
Zurück zum Zitat Meduri GU, Tolley EA, Chinn A, Stentz F, Postlethwaite A (1998) Procollagen types I and III aminoterminal propeptide levels during acute respiratory distress syndrome and in response to methylprednisolone treatment. Am J Respir Crit Care Med 158:1432–1441CrossRefPubMed Meduri GU, Tolley EA, Chinn A, Stentz F, Postlethwaite A (1998) Procollagen types I and III aminoterminal propeptide levels during acute respiratory distress syndrome and in response to methylprednisolone treatment. Am J Respir Crit Care Med 158:1432–1441CrossRefPubMed
28.
Zurück zum Zitat Meduri GU, Muthiah MP, Carratu P, Eltorky M, Chrousos GP (2005) Nuclear factor-kappaB- and glucocorticoid receptor alpha-mediated mechanisms in the regulation of systemic and pulmonary inflammation during sepsis and acute respiratory distress syndrome. Evidence for inflammation-induced target tissue resistance to glucocorticoids. NeuroImmunoModulation 12:321–338CrossRefPubMed Meduri GU, Muthiah MP, Carratu P, Eltorky M, Chrousos GP (2005) Nuclear factor-kappaB- and glucocorticoid receptor alpha-mediated mechanisms in the regulation of systemic and pulmonary inflammation during sepsis and acute respiratory distress syndrome. Evidence for inflammation-induced target tissue resistance to glucocorticoids. NeuroImmunoModulation 12:321–338CrossRefPubMed
29.
Zurück zum Zitat Meduri GU, Headley S, Tolley E, Shelby M, Stentz F, Postlethwaite A (1995) Plasma and BAL cytokine response to corticosteroid rescue treatment in late ARDS. Chest 108:1315–1325CrossRefPubMed Meduri GU, Headley S, Tolley E, Shelby M, Stentz F, Postlethwaite A (1995) Plasma and BAL cytokine response to corticosteroid rescue treatment in late ARDS. Chest 108:1315–1325CrossRefPubMed
30.
Zurück zum Zitat Meduri GU, Tolley EA, Chrousos GP, Stentz F (2002) Prolonged methylprednisolone treatment suppresses systemic inflammation in patients with unresolving acute respiratory distress syndrome. Evidence for inadequate endogenous glucocorticoid secretion and inflammation-induced immune cell resistance to glucocorticoids. Am J Respir Crit Care Med 165:983–991CrossRefPubMed Meduri GU, Tolley EA, Chrousos GP, Stentz F (2002) Prolonged methylprednisolone treatment suppresses systemic inflammation in patients with unresolving acute respiratory distress syndrome. Evidence for inadequate endogenous glucocorticoid secretion and inflammation-induced immune cell resistance to glucocorticoids. Am J Respir Crit Care Med 165:983–991CrossRefPubMed
31.
Zurück zum Zitat Sinclair SE, Bijoy J, Golden E, Carratu P, Umberger R, Meduri GU (2006) Interleukin-8 and soluble intercellular adhesion molecule-1 during acute respiratory distress syndrome and in response to prolonged methylprednisolone treatment. Minerva Pneumol 45:93–104 Sinclair SE, Bijoy J, Golden E, Carratu P, Umberger R, Meduri GU (2006) Interleukin-8 and soluble intercellular adhesion molecule-1 during acute respiratory distress syndrome and in response to prolonged methylprednisolone treatment. Minerva Pneumol 45:93–104
32.
Zurück zum Zitat Henzen C, Suter A, Lerch E, Urbinelli R, Schorno XH, Briner VA (2000) Suppression and recovery of adrenal response after short-term, high- dose glucocorticoid treatment. Lancet 355:542–545CrossRefPubMed Henzen C, Suter A, Lerch E, Urbinelli R, Schorno XH, Briner VA (2000) Suppression and recovery of adrenal response after short-term, high- dose glucocorticoid treatment. Lancet 355:542–545CrossRefPubMed
34.
Zurück zum Zitat Nawab Q, Golden E, Confalonieri M, Umberger R, Meduri G (2011) Corticosteroid treatment in severe community-acquired pneumonia: duration of treatment affects control of systemic inflammation and clinical improvement. Intensive Care Med 37:1153–1554CrossRef Nawab Q, Golden E, Confalonieri M, Umberger R, Meduri G (2011) Corticosteroid treatment in severe community-acquired pneumonia: duration of treatment affects control of systemic inflammation and clinical improvement. Intensive Care Med 37:1153–1554CrossRef
35.
Zurück zum Zitat Meduri GU (2007) There is no illumination in speculation. Additional data in support of methylprednisolone treatment in ARDS. Chest 132:1097–1100CrossRef Meduri GU (2007) There is no illumination in speculation. Additional data in support of methylprednisolone treatment in ARDS. Chest 132:1097–1100CrossRef
36.
Zurück zum Zitat Thompson BT, Ancukiewicz M, Hudson LD, Steinberg KP, Bernard GR (2007) Steroid treatment for persistent ARDS: a word of caution. Crit Care 11:425CrossRefPubMedPubMedCentral Thompson BT, Ancukiewicz M, Hudson LD, Steinberg KP, Bernard GR (2007) Steroid treatment for persistent ARDS: a word of caution. Crit Care 11:425CrossRefPubMedPubMedCentral
37.
Zurück zum Zitat Marik PE, Pastores S, Annane D, Meduri G, Sprung C, Arlt W, Keh D, Briegel J, Beishuizen A, Dimopoulou I, Tsagarakis S, Singer M, Chrousos GP, Zaloga GP, Bokhari F, Vogeser M (2008) Clinical practice guidelines for the diagnosis and management of corticosteroid insufficiency in critical illness: recommendations of an international task force. Crit Care Med 36:1937–1949CrossRefPubMed Marik PE, Pastores S, Annane D, Meduri G, Sprung C, Arlt W, Keh D, Briegel J, Beishuizen A, Dimopoulou I, Tsagarakis S, Singer M, Chrousos GP, Zaloga GP, Bokhari F, Vogeser M (2008) Clinical practice guidelines for the diagnosis and management of corticosteroid insufficiency in critical illness: recommendations of an international task force. Crit Care Med 36:1937–1949CrossRefPubMed
38.
Zurück zum Zitat Siemieniuk RA, Meade MO, Alonso-Coello P, Briel M, Evaniew N, Prasad M, Alexander PE, Fei Y, Vandvik PO, Loeb M, Guyatt GH (2015) Corticosteroid therapy for patients hospitalized with community-acquired Pneumonia: A systematic review and meta-analysis. Ann Intern Med 163(7):519–528 Siemieniuk RA, Meade MO, Alonso-Coello P, Briel M, Evaniew N, Prasad M, Alexander PE, Fei Y, Vandvik PO, Loeb M, Guyatt GH (2015) Corticosteroid therapy for patients hospitalized with community-acquired Pneumonia: A systematic review and meta-analysis. Ann Intern Med 163(7):519–528
39.
Zurück zum Zitat Greos LS, Vichyanond P, Bloedow DC, Irvin CG, Larsen GL, Szefler SJ, Hill MR (1991) Methylprednisolone achieves greater concentrations in the lung than prednisolone. A pharmacokinetic analysis. Am Rev Respir Dis 144:586–592CrossRefPubMed Greos LS, Vichyanond P, Bloedow DC, Irvin CG, Larsen GL, Szefler SJ, Hill MR (1991) Methylprednisolone achieves greater concentrations in the lung than prednisolone. A pharmacokinetic analysis. Am Rev Respir Dis 144:586–592CrossRefPubMed
40.
Zurück zum Zitat Jantz MA, Sahn SA (1999) Corticosteroids in acute respiratory failure. Am J Respir Crit Care Med 160:1079–1100CrossRefPubMed Jantz MA, Sahn SA (1999) Corticosteroids in acute respiratory failure. Am J Respir Crit Care Med 160:1079–1100CrossRefPubMed
41.
Zurück zum Zitat Gupta L, James B (2012) Prone position and intravenous steroids for the management of severe ARDS. Thorax 67:A38CrossRef Gupta L, James B (2012) Prone position and intravenous steroids for the management of severe ARDS. Thorax 67:A38CrossRef
42.
Zurück zum Zitat Papazian L, Forel JM, Gacouin A, Penot-Ragon C, Perrin G, Loundou A, Jaber S, Arnal JM, Perez D, Seghboyan JM, Constantin JM, Courant P, Lefrant JY, Guerin C, Prat G, Morange S, Roch A, Investigators AS (2010) Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med 363:1107–1116CrossRefPubMed Papazian L, Forel JM, Gacouin A, Penot-Ragon C, Perrin G, Loundou A, Jaber S, Arnal JM, Perez D, Seghboyan JM, Constantin JM, Courant P, Lefrant JY, Guerin C, Prat G, Morange S, Roch A, Investigators AS (2010) Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med 363:1107–1116CrossRefPubMed
43.
Zurück zum Zitat Dunser M, Hasibeder W, Rieger M, Mayr AJ (2004) Successful therapy of severe pneumonia-associated ARDS after pneumonectomy with ECMO and steroids. Ann Thorac Surg 78:335–337CrossRefPubMed Dunser M, Hasibeder W, Rieger M, Mayr AJ (2004) Successful therapy of severe pneumonia-associated ARDS after pneumonectomy with ECMO and steroids. Ann Thorac Surg 78:335–337CrossRefPubMed
44.
Zurück zum Zitat Gomez Manjarres D, Gay E (2015) A promising combination for treating blastomyces induced ARDS. Am J Respir Crit Care Med 191:A1690 Gomez Manjarres D, Gay E (2015) A promising combination for treating blastomyces induced ARDS. Am J Respir Crit Care Med 191:A1690
Metadaten
Titel
Prolonged glucocorticoid treatment is associated with improved ARDS outcomes: analysis of individual patients’ data from four randomized trials and trial-level meta-analysis of the updated literature
verfasst von
G. Umberto Meduri
Lisa Bridges
Mei-Chiung Shih
Paul E. Marik
Reed A. C. Siemieniuk
Mehmet Kocak
Publikationsdatum
27.10.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Intensive Care Medicine / Ausgabe 5/2016
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-015-4095-4

Weitere Artikel der Ausgabe 5/2016

Intensive Care Medicine 5/2016 Zur Ausgabe

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.