Patients with acute respiratory distress should not receive steroid
Patients with persistent acute respiratory distress syndrome (ARDS) do not benefit from the use of corticosteroid treatment, according to the authors of a new study (New England Journal of Medicine 2006;354:1671).
Patients with ARDS of at least seven days’ duration — characterised
by inflammation, the accumulation of fluid in the lungs and the need
for prolonged ventilation — were randomised to receive either methylprednisolone
or placebo. Mortality rate at 60 days was not shown to be different between
the two groups (treatment group 29.2 per cent versus placebo group 28.6
per cent; P=1.0).
However, the authors found that methylprednisolone treatment, given 14
days or later after the onset of ARDS, was associated with higher mortality
rates at 60 days (35 per cent versus 8 per cent; P=0.02) and at 180 days
(44 per cent versus 12 per cent; P=0.01).
An editorial in the same issue (ibid, p1739) highlights a subgroup analysis
of patients receiving treatment seven to 13 days after the onset of ARDS,
which showed 25 per cent lower mortality at 60 and 180 days — a
difference not reaching statistical significance.
Although the authors of the study conclude that their results do not
support routine use of methylprednisolone for persistent ARDS, the editorial
says that the data suggest “a narrow window of opportunity — between
seven and 14 days after the onset of the disease — in which cardiopulmonary
function and possibly outcome may be improved”. |
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