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01.01.2008 | Clinical Commentary

Steroid treatment in ARDS: a critical appraisal of the ARDS network trial and the recent literature

verfasst von: G. Umberto Meduri, Paul E. Marik, George P. Chrousos, Stephen M. Pastores, Wiebke Arlt, Albertus Beishuizen, Faran Bokhari, Gary Zaloga, Djillali Annane

Erschienen in: Intensive Care Medicine | Ausgabe 1/2008

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Abstract

Objectives

To compare the design and results of randomized trials investigating prolonged glucocorticoid treatment (≥ 7 days) in patients with acute lung injury–acute respiratory distress syndrome (ALI–ARDS), and review factors affecting response to therapy, including the role of secondary prevention.

Design

Trials were retrieved from the Cochrane Central Register of Controlled Trials (CENTRAL). Two investigators collected data on study characteristics, treatment intervention, and outcomes. The methodological quality of trials was determined and data were analyzed with Review Manager 4.2.3.

Measurements and results

Five selected trials (n = 518) consistently reported significant improvement in gas exchange, reduction in markers of inflammation, and decreased duration of mechanical ventilation and intensive care unit stay (all p < 0.05). Two early small clinical trials showed marked reductions in the relative risk (RR) of death with glucocorticoid therapy (RR = 0.14, 95% CI 0.04–0.53; p = 0.004, I² = 0%). Three subsequent larger trials, when combined, although nominally beneficial, did not reproduce the marked reductions observed in the earlier trials (RR = 0.84; 95% CI 0.68–1.03; p = 0.09, I² = 9.1%), but achieved a distinct reduction in the RR of death in the larger subgroup of patients (n = 400) treated before day 14 of ARDS [82/214 (38%) vs. 98/186 (52.5%), RR = 0.78; 95% CI 0.64–0.96; p = 0.02, I² = 0%].

Conclusions

Prolonged glucocorticoid treatment substantially and significantly improves meaningful patient-centered outcome variables, and has a distinct survival benefit when initiated before day 14 of ARDS.

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Titel: Steroid treatment in ARDS: a critical appraisal of the ARDS network trial and the recent literature
verfasst von: G. Umberto Meduri
Paul E. Marik
George P. Chrousos
Stephen M. Pastores
Wiebke Arlt
Albertus Beishuizen
Faran Bokhari
Gary Zaloga
Djillali Annane
Publikationsdatum: 01.01.2008
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 1/2008
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-007-0933-3

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Steroid treatment in ARDS: a critical appraisal of the ARDS network trial and the recent literature