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Corticosteroids in the prevention and treatment of acute respiratory distress syndrome (ARDS): meta-analysis

Corticosteroids in the prevention and treatment of acute respiratory distress syndrome (ARDS): meta-analysis
Corticosteroids in the prevention and treatment of acute respiratory distress syndrome (ARDS): meta-analysis
Objective To systematically review the efficacy of steroids in the prevention of acute respiratory distress syndrome (ARDS) in critically ill adults, and treatment for established ARDS.

Data sources Search of randomised controlled trials (1966-April 2007) of PubMed, Cochrane central register of controlled trials, Cochrane database of systematic reviews, American College of Physicians Journal Club, health technology assessment database, and database of abstracts of reviews of effects.

Data extraction Two investigators independently assessed trials for inclusion and extracted data into standardised forms; differences were resolved by consensus.

Data synthesis Steroid efficacy was assessed through a Bayesian hierarchical model for comparing the odds of developing ARDS and mortality (both expressed as odds ratio with 95% credible interval) and duration of ventilator free days, assessed as mean difference. Bayesian outcome probabilities were calculated as the probability that the odds ratio would be ?1 or the probability that the mean difference would be ?0. Nine randomised trials using variable dose and duration of steroids were identified. Preventive steroids (four studies) were associated with a trend to increase both the odds of patients developing ARDS (odds ratio 1.55, 95% credible interval 0.58 to 4.05; P(odds ratio ?1)=86.6%), and the risk of mortality in those who subsequently developed ARDS (three studies, odds ratio 1.52, 95% credible interval 0.30 to 5.94; P(odds ratio ?1)=72.8%). Steroid administration after onset of ARDS (five studies) was associated with a trend towards reduction in mortality (odds ratio 0.62, 95% credible interval 0.23 to 1.26; P(odds ratio ?1)=6.8%). Steroid therapy increased the number of ventilator free days compared with controls (three studies, mean difference 4.05 days, 95% credible interval 0.22 to 8.71; P(mean difference ?0)=97.9%). Steroids were not associated with increase in risk of infection.

Conclusions A definitive role of corticosteroids in the treatment of ARDS in adults is not established. A possibility of reduced mortality and increased ventilator free days with steroids started after the onset of ARDS was suggested. Preventive steroids possibly increase the incidence of ARDS in critically ill adults.
0959-8138
1006-1009
Peter, John Victor
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John, Preeta
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Graham, Petra L.
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Moran, John L.
9f0df865-df0c-4cc3-a91d-5177e8144fea
George, Ige Abraham
e484aeba-45ee-4af0-994c-6440d1ebe72f
Bersten, Andrew
f2aa0c42-c761-488b-aad8-f7b20c44a8dc
Peter, John Victor
f6512d39-1769-4452-8b46-83331d29e57b
John, Preeta
1eebe4c4-5cbe-45f6-a03b-baf4c35c79e8
Graham, Petra L.
be78db94-e891-4d1a-9037-06a01dc3a4c3
Moran, John L.
9f0df865-df0c-4cc3-a91d-5177e8144fea
George, Ige Abraham
e484aeba-45ee-4af0-994c-6440d1ebe72f
Bersten, Andrew
f2aa0c42-c761-488b-aad8-f7b20c44a8dc

Peter, John Victor, John, Preeta, Graham, Petra L., Moran, John L., George, Ige Abraham and Bersten, Andrew (2008) Corticosteroids in the prevention and treatment of acute respiratory distress syndrome (ARDS): meta-analysis. BMJ, 3 (336), 1006-1009, [7651]. (doi:10.1136/bmj.39537.939039.BE).

Record type: Article

Abstract

Objective To systematically review the efficacy of steroids in the prevention of acute respiratory distress syndrome (ARDS) in critically ill adults, and treatment for established ARDS.

Data sources Search of randomised controlled trials (1966-April 2007) of PubMed, Cochrane central register of controlled trials, Cochrane database of systematic reviews, American College of Physicians Journal Club, health technology assessment database, and database of abstracts of reviews of effects.

Data extraction Two investigators independently assessed trials for inclusion and extracted data into standardised forms; differences were resolved by consensus.

Data synthesis Steroid efficacy was assessed through a Bayesian hierarchical model for comparing the odds of developing ARDS and mortality (both expressed as odds ratio with 95% credible interval) and duration of ventilator free days, assessed as mean difference. Bayesian outcome probabilities were calculated as the probability that the odds ratio would be ?1 or the probability that the mean difference would be ?0. Nine randomised trials using variable dose and duration of steroids were identified. Preventive steroids (four studies) were associated with a trend to increase both the odds of patients developing ARDS (odds ratio 1.55, 95% credible interval 0.58 to 4.05; P(odds ratio ?1)=86.6%), and the risk of mortality in those who subsequently developed ARDS (three studies, odds ratio 1.52, 95% credible interval 0.30 to 5.94; P(odds ratio ?1)=72.8%). Steroid administration after onset of ARDS (five studies) was associated with a trend towards reduction in mortality (odds ratio 0.62, 95% credible interval 0.23 to 1.26; P(odds ratio ?1)=6.8%). Steroid therapy increased the number of ventilator free days compared with controls (three studies, mean difference 4.05 days, 95% credible interval 0.22 to 8.71; P(mean difference ?0)=97.9%). Steroids were not associated with increase in risk of infection.

Conclusions A definitive role of corticosteroids in the treatment of ARDS in adults is not established. A possibility of reduced mortality and increased ventilator free days with steroids started after the onset of ARDS was suggested. Preventive steroids possibly increase the incidence of ARDS in critically ill adults.

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Published date: 3 May 2008

Identifiers

Local EPrints ID: 66524
URI: http://eprints.soton.ac.uk/id/eprint/66524
ISSN: 0959-8138
PURE UUID: 55bbbef2-9386-4932-8f5e-95b13d115f26

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Date deposited: 29 Jun 2009
Last modified: 13 Mar 2024 18:24

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Contributors

Author: John Victor Peter
Author: Preeta John
Author: Petra L. Graham
Author: John L. Moran
Author: Ige Abraham George
Author: Andrew Bersten

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