Manoj J Mammen1, Komal Aryal2, Waleed Alhazzani3, Paul E Alexander2. 1. Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, United States. mmammen@gmail.com 2. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada 3. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Abstract
INTRODUCTION: Acute respiratory distress syndrome (ARDS) is a rapidly progressing, inflammatory lung disease with a high mortality rate and no specific pharmacological treatment available. OBJECTIVES: We conducted a systematic review and meta‑analysis on corticosteroid use in ARDS. METHODS: We searched 4 medical literature databases and retained randomized controlled trials on the use of corticosteroids in hospitalized adults with ARDS, which could be found there until February 2020. Two reviewers identified eligible studies, independently extracted data, and evaluated the risk of bias. The authors assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. RESULTS: We included 7 randomized controlled trials involving 851 patients. They showed that corticosteroids reduced all‑cause mortality (risk ratio [RR], 0.75; 95% CI, 0.59-0.95; P = 0.02; moderate certainty) and the duration of mechanical ventilation (mean difference [MD], -4.93 days; 95% CI; -7.81 to -2.06; P <0.001; low certainty), and increased the number of ventilator‑free days (MD, 4.28 days; 95% CI, 2.67-5.88; P <0.001; moderate certainty), as compared with placebo. Corticosteroids also increased the risk of hyperglycemia (RR, 1.12%; 95% CI, 1.01-1.24; P = 0.03; moderate certainty), and the effect on neuromuscular weakness was unclear (RR, 1.3; 95% CI, 0.8-2.11; P = 0.28; low certainty). CONCLUSIONS: These results suggest that systemic corticosteroids may potentially improve mortality, shorten ventilation times, and increase the number of ventilator‑free days in patients with ARDS. However, the studies included different corticosteroid classes and initiated drug administration at different times, as well as used various dosing regimens. Thus, caution in the actual clinical application of these results is recommended.
INTRODUCTION: Acute respiratory distress syndrome (ARDS) is a rapidly progressing, inflammatory lung disease with a high mortality rate and no specific pharmacological treatment available. OBJECTIVES: We conducted a systematic review and meta‑analysis on corticosteroid use in ARDS. METHODS: We searched 4 medical literature databases and retained randomized controlled trials on the use of corticosteroids in hospitalized adults with ARDS, which could be found there until February 2020. Two reviewers identified eligible studies, independently extracted data, and evaluated the risk of bias. The authors assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. RESULTS: We included 7 randomized controlled trials involving 851 patients. They showed that corticosteroids reduced all‑cause mortality (risk ratio [RR], 0.75; 95% CI, 0.59-0.95; P = 0.02; moderate certainty) and the duration of mechanical ventilation (mean difference [MD], -4.93 days; 95% CI; -7.81 to -2.06; P <0.001; low certainty), and increased the number of ventilator‑free days (MD, 4.28 days; 95% CI, 2.67-5.88; P <0.001; moderate certainty), as compared with placebo. Corticosteroids also increased the risk of hyperglycemia (RR, 1.12%; 95% CI, 1.01-1.24; P = 0.03; moderate certainty), and the effect on neuromuscular weakness was unclear (RR, 1.3; 95% CI, 0.8-2.11; P = 0.28; low certainty). CONCLUSIONS: These results suggest that systemic corticosteroids may potentially improve mortality, shorten ventilation times, and increase the number of ventilator‑free days in patients with ARDS. However, the studies included different corticosteroid classes and initiated drug administration at different times, as well as used various dosing regimens. Thus, caution in the actual clinical application of these results is recommended.
Authors: Dipayan Chaudhuri; Kiyoka Sasaki; Aram Karkar; Sameer Sharif; Kimberly Lewis; Manoj J Mammen; Paul Alexander; Zhikang Ye; Luis Enrique Colunga Lozano; Marie Warrer Munch; Anders Perner; Bin Du; Lawrence Mbuagbaw; Waleed Alhazzani; Stephen M Pastores; John Marshall; François Lamontagne; Djillali Annane; Gianfranco Umberto Meduri; Bram Rochwerg Journal: Intensive Care Med Date: 2021-04-19 Impact factor: 17.440