Review: Low-dose corticosteroids improve outcomes in acute lung injury and the acute respiratory distress syndrome

In patients with acute lung injury (ALI) or the acute respiratory distress syndrome (ARDS), do low-dose corticosteroids improve outcomes?

Included studies compared low-dose corticosteroids (0.5 to 2.5 mg/kg per d of methylprednisolone or equivalent) with placebo or no corticosteroids in adults with ALI or ARDS. Outcomes included hospital mortality, duration of mechanical ventilation, length of intensive care unit stay, Multiple Organ Dysfunction Syndrome Score, Lung Injury Score, and adverse events.

MEDLINE, EMBASE/Excerpta Medica, Current Contents, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (to Sep 2007); and references were searched for randomized controlled trials (RCTs) and cohort studies. 4 placebo-controlled RCTs (n = 341) and 5 cohort studies (n = 307) met the selection criteria (mean age 51 y, 70% men). Corticosteroid dose ranged from 40 to 250 mg/d of methylprednisolone or equivalent (mean 140 mg/d). Duration of treatment ranged from 7 to 32 days (mean 8 d).

In separate meta-analyses of RCTs and cohort studies, the reductions in mortality with corticosteroids were similar but did not reach statistical significance; however, when all studies were combined, the reduction was statistically significant (Table). Corticosteroids improved measures of morbidity (Table) but did not increase rates of infection, neuromyopathy, or total major adverse events.

In patients with acute lung injury or the acute respiratory distress syndrome, low-dose corticosteroids improve mortality and morbidity without increasing risk for adverse events.