by Ping Lin, Yuean Zhao, Xiaoqian Li, Faming Jiang and
Zongan Liang
Critical Care volume 25,
Article number: 122 (2021)
Background
The possible benefits associated with corticosteroid
treatment in acute respiratory distress syndrome (ARDS) patients are not fully
known. We conducted an updated meta-analysis to assess the effect of
corticosteroids in the treatment of patients with ARDS.
Methods
We systematically searched MEDLINE, Embase, and the Cochrane
Library from inception to January 2021 via Ovid to identify randomized
controlled trials evaluating the efficacy of glucocorticoids in the treatment
of patients with ARDS. The primary outcome was hospital mortality. Secondary
outcomes included the number of ventilator-free days at day 28, oxygenation
improvement (PaO2/FIO2 ratios), and adverse events.
Results
Nine studies with 1371 participants were analyzed. The
pooled analysis revealed that glucocorticoid use was associated with reduced
mortality [relative risk (RR), 0.83; 95% confidence interval (CI)
0.74–0.93; P < 0.01; I2 = 37], and the statistical power was
confirmed by trial sequential analysis. Glucocorticoids might also significantly
increase the number of ventilator-free days at day 28 (mean deviation
3.66 days, 95% CI 2.64–4.68; P < 0.01) and improve oxygenation
(standardized mean difference 4.17; 95% CI 2.32–6.02; P < 0.01). In
addition, glucocorticoid use was not associated with increased risks of new
infection (RR 0.84; 95% CI 0.70–1.01; P = 0.07) and hyperglycemia (RR
1.11; 95% CI 0.99–1.23; P = 0.06).
Conclusions
The use of glucocorticoids might result in reduced mortality
in patients with ARDS. Glucocorticoids might be recommended as an adjunct to
standard care for ARDS; however, the optimal dose and duration of steroid
therapy remains unknown and further studies are needed.
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