Corticosteroids May Reduce Mortality in Patients With ARDS
Mechanical ventilation duration and overall mortality among patients with established moderate to severe acute respiratory distress syndrome (ARDS) may be reduced with early administration of dexamethasone, according to results of a new study.
“There is no proven specific pharmacological treatment for patients with ARDS. The efficacy of corticosteroids in ARDS remains controversial,” the researchers wrote.
To assess the effects of dexamethasone in ARDS, the researchers enrolled 277 patients from 17 intensive care units (ICUs) in teaching hospitals across Spain between March 28, 2013, and December 31, 2018.
To be eligible, the patients had to have had established moderate to severe ARDS, which was defined by a ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen of 200 mm Hg or less assessed with a positive end-expiratory pressure of 10 cm H2O or more and FiO2 of 0.5 or more at 24 hours after ARDS onset.
Among all the participants, 139 were randomly assigned to the dexamethasone group and 138 were randomly assigned to the control group. Those in the dexamethasone group received an intravenous dose of 20 mg once daily from day 1 to day 5. The dose was reduced to 10 mg once daily from day 6 to day 10. Participants in both groups received lung-protective mechanical ventilation.
The primary outcome was the number of ventilator-free days at 28 days, which was defined as the number of days alive and free from mechanical ventilation from day of randomization to day 28. The dexamethasone group had a higher mean number of ventilator-free days than the control group; the between-group difference was 4.8 days.
The secondary outcome was all-cause mortality 60 days after randomization. At 60 days, 29 (21%) participants in the dexamethasone group and 50 (36%) participants in the control group had died.
The proportion of adverse events—the most common of which were hyperglycemia in the ICU, new infections in the ICU, and barotrauma—did not differ significantly between the groups.
—Colleen Murphy
Reference:
Villar J, Ferrando C, Martínez D, et al; dexamethasone in ARDS network. Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial. Lancet Respir Med. 2020;8(3):267-276. https://doi.org/10.1016/S2213-2600(19)30417-5.