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Steroids May Be of Benefit In Late Stage ARDS

Question

  • In children with late stage ARDS, does prolonged methylprednisolone therapy result in improved morbidity or mortality?

Clinical Bottom Lines

  1. In a series of small studies in adults, steroids have shown to lead to a survival benefit in late stage ARDS. The clinical application is reserved to late stage ARDS in critically ill PICU patients who are not improving with conventional management.


Summary of Key Evidence

  1. The study group had improved oxygenation, decreased multi organ dysfuntion score and more successful extubation attempts by day 10 of treatment.
  2. Mortality in the treatment group was 0/16 vs. 5/8 in the placebo group.
  3. Rate of infection and pneumonia were similar in both groups.

Additional Comments

  • The only significant evidence has been in small trials in adults only, so possibly has limited applications in children.
  • Steroids appear to have benefits only in late stage ARDS (previous studies in early ARDS have not shown benefit) possibly because of effects on fibrosis that occurs at this stage of the disease process.
  • Side effects of steroids such as overwhelming infection (especially fungal sepsis) were noted in one patient in the treatment group. Other side effects such as hypertension, insulin resistance, etc. were not specifically mentioned.

Citation

  1. Meduri GE, et al. Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome: A randomized controlled trial. JAMA 1998; 280(2): 159-65.
  2. Goh A, et al. Corticosteroid rescues in late paediatric acute respiratory distress syndrome. Respirology 1999; 4: 295-97.

CAT Author: Erica Markovitz, MD

CAT Appraisers: John G. Frohna, MD, MPH

Date appraised: June 16, 2004

Last updated October 27, 2004
Department of Pediatrics and Communicable Diseases
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