Methylprednisolone improves outcomes in ARDS

Daily POEMs

Published: 2007-06-28 © 2007 John Wiley & Sons, Inc.

Clinical question
Does prolonged methylprednisolone administered to patients with ARDS reduce lung injury and improve patient outcomes?

Bottom line
Methylprednisolone initiated early in the course of acute respiratory distress syndrome (ARDS) reduces the duration of mechanical ventilation and mortality in the intensive care unit (ICU). (LOE = 1b)

Reference
Meduri GU, Golden E, Freire AX, et al. Methylprednisolone infusion in early severe ARDS: results of a randomized trial. Chest 2007;131:954-963.

Study design: Randomized controlled trial (double-blinded)

Funding source: Foundation

Allocation: Uncertain

Setting: Inpatient (ICU only)

Synopsis
This was a multicenter study that randomized 91 patients within 72 hours of the diagnosis of ARDS to receive either methylprednisolone infusion or placebo. Unlike other studies of steroid use in ARDS, this study used a lower dose and more prolonged administration of methylprednisolone (1 mg/kg/day for 14 days, then tapered over 14 days). Groups were similar at baseline except for a higher percentage of patients with catecholamine-dependent shock in the control group. Data were analyzed by intention to treat and outcome assessors were blinded to treatment assignment. At day 7, significantly more steroid-treated patients had improvement in lung injury score and were breathing without assistance (54% vs 25%; P = .01; number needed to treat = 4). At day 7, the methylprednisolone group had significantly lower rates of lung, cardiovascular, and hepatic dysfunction. The treatment group also had an overall reduction in the duration of mechanical ventilation and ICU mortality, with a trend toward improved hospital mortality. The rate of infectious complications was lower in the steroid group. Neuromuscular blocking agents were avoided, and this complication did differ between groups. Although this study had a small enrollment, the benefits of prolonged moderate-dose steroids on lung function and clinical outcomes were significant.

Copyright © 2007 John Wiley & Sons, Inc.