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Critical Care
Published in: Critical Care 1/2017

Open Access 01-12-2017 | Letter

Do we know enough to recommend corticosteroids in acute respiratory distress syndrome?

Authors: Mathieu Blot, Arnaud Salmon-Rousseau, Pascal Chavanet, Lionel Piroth

Published in: Critical Care | Issue 1/2017

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Excerpt

We read with interest the evidence-based recommendations for the use of prolonged corticosteroids in early moderate to severe acute respiratory distress syndrome (ARDS) published in Critical Care Medicine by the Corticosteroid Guideline Task Force of SCCM and ESICM [1]. Whether corticosteroids have to be administered in adult patients with ARDS remains a matter of debate. Based on nine randomized controlled trials (RCTs), including eight RCTs selected in the meta-analysis of Meduri et al. [2] and one additional recent RCT [3], the task force found that the use of prolonged corticosteroids in early ARDS has a beneficial effect on in-hospital mortality (RR 0.64, 95% CI 0.46 to 0.89) [1]. However, several caveats and limitations must be pointed out. …
Literature
1.
Annane D, Pastores SM, Rochwerg B, et al. Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. Crit Care Med. 2017;45:2078–88.CrossRefPubMed
2.
Meduri GU, Bridges L, Shih M-C, et al. Prolonged glucocorticoid treatment is associated with improved ARDS outcomes: analysis of individual patients’ data from four randomized trials and trial-level meta-analysis of the updated literature. Intensive Care Med. 2016;42:829–40.CrossRefPubMed
3.
Tongyoo S, Permpikul C, Mongkolpun W, et al. Hydrocortisone treatment in early sepsis-associated acute respiratory distress syndrome: results of a randomized controlled trial. Crit Care. 2016;20:329.CrossRefPubMedPubMedCentral
4.
Keh D, Trips E, Marx G, et al. Effect of hydrocortisone on development of shock among patients with severe sepsis: the HYPRESS randomized clinical trial. JAMA. 2016;316:1775–85.CrossRefPubMed
5.
Ruan S-Y, Lin H-H, Huang C-T, et al. Exploring the heterogeneity of effects of corticosteroids on acute respiratory distress syndrome: a systematic review and meta-analysis. Crit Care. 2014;18:R63.CrossRefPubMedPubMedCentral
Metadata
Title
Do we know enough to recommend corticosteroids in acute respiratory distress syndrome?
Authors
Mathieu Blot
Arnaud Salmon-Rousseau
Pascal Chavanet
Lionel Piroth
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2017
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-017-1920-x

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