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 2024/04/20
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.