Evidence-based support for prolonged glucocorticoid treatment in acute lung injury/acute respiratory distress syndrome.

摘要

We read with interest the section on glucocorticoid treatment in acute respiratory distress syndrome (ARDS) by Diaz et al (1) and wish to add to the topic. We recently published an extensive review on the subject (2) and participated in the development of clinical practice guidelines for corticosteroid insufficiency in critical illness (3). The appraised experimental and translational research provides strong biological support for prolonged glucocorticoid treatment in acute lung injury/ARDS (2). Eight controlled studies (five randomized [n = 518] and three concurrent case-controlled [n = 110] [2, 4]) consistently reported significant improvement for patient-centered outcomes. Eight reported a significant reduction in markers of systemic inflammation and improvement in oxygenation and/or lung injury score, six reported improvement in multiple organ dysfunction and reduction in duration of mechanical ventilation, and five reported reduction in intensive care unit stay (all p values < .05).