RT Book, Section A1 Marik, Paul E. A2 Oropello, John M. A2 Pastores, Stephen M. A2 Kvetan, Vladimir SR Print(0) ID 1136418238 T1 Controversies: Corticosteroids for ARDS: Friend or Foe? T2 Critical Care YR 1 FD 1 PB McGraw-Hill Education PP New York, NY SN 9780071820813 LK accessanesthesiology.mhmedical.com/content.aspx?aid=1136418238 RD 2024/10/13 AB The acute respiratory distress syndrome (ARDS) is a common and vexing problem faced by critical care providers worldwide. Despite extensive investigation over the last three decades, the impact of ARDS in terms of morbidity, mortality, and health care costs remains very high. In the United States alone, ARDS affects as many as 200,000 people per year with a mortality rate from 30% to 50% and costs in excess of $60,000 per hospitalization.1,2 The management of patients with ARDS is essentially supportive using a lung protective ventilatory strategy and treatment of the precipitating cause.3 The use of corticosteroids in patients with ARDS is controversial with widely dissenting opinions on this topic.4 At least 6 meta-analyses have been performed with conflicting conclusions.5,6,7,8,9,10 However, a summation of this data would suggest that glucocorticoids (GCs) improve oxygenation, increase the number of ventilator-free days, decrease intensive care unit (ICU) and hospital length of stay with a possible mortality benefit with no clear evidence of an increase in complications. Despite the potential benefit of GCs in patients with ARDS, survey data suggest that most clinicians do not prescribe these agents to their patients with ARDS.11 The purpose of this review is to outline the rationale for GC treatment in ARDS, discuss the factors affecting response to treatment, review the results of clinical trials and the myths concerning GC-related side effects and outline a protocol for GC treatment based on the best available data.