Nine RCTs (n=1,073) were included in the review. Four studies evaluated the preventive use of steroids and 5 studies assessed steroid use after ARDS onset.
The trial quality scores ranged from 6 to 8 out of 10.
For studies examining preventive use, there was an 86.6% probability of an OR ≥1, suggesting evidence of an association between steroid therapy and the development of ARDS (OR 1.55, 95% CrI: 0.58, 4.05). There was also a weakly increased risk of death (72.8% probability of an OR ≥1) associated with steroid use in patients who went on to develop ARDS (OR 1.52, 95% CrI: 0.30, 5.94).
For studies examining therapeutic use, there was a 6.8% probability of an OR ≥1, suggesting that steroids were associated with a trend towards reduced mortality (OR 0.62, 95% CrI: 0.23, 1.26). Steroid therapy was associated with more ventilator-free days (mean difference 4.05 days, 95% CrI: 0.22, 8.71).
Heterogeneity was observed between the studies and was particularly evident in analyses looking at the development of pneumonia (SD=1.34).
The meta-regression showed a trend towards an increased number of patients developing new infections as the steroid dose increased, although no evidence of an association was found between odds of mortality and time to treatment, total steroid dose, or year of study completion. Further analyses were reported.