Ten RCTs (n=1,088) were included in the review. The sample sizes ranged from 24 to 304 participants.
Early, short-course, high-dose corticosteroids: Three of four trials reported no significant difference in progression to acute respiratory distress syndrome; one reported a significant increase in progression to acute respiratory distress syndrome in the corticosteroid group. Three of the trials reported no significant difference in mortality when all patients were considered. One of these trials included some patients with acute respiratory distress syndrome at baseline. One trial treatment for acute respiratory distress syndrome reported no significant difference between corticosteroids and controls for 45-day mortality.
Low-dose, prolonged-duration corticosteroids: The results were inconsistent for the treatment of late-phase acute respiratory distress syndrome with corticosteroids. One trial reported 13% hospital mortality in the treatment group compared to 63% in the inactive treatment group (p=0.03), however another trial reported no significant difference between groups for 60-day mortality. One trial reported that patients who received early-phase acute respiratory distress syndrome treatment were more likely to have improved lung function (p=0.002), be free of mechanical ventilation (p=0.001), and have a lower mean lung injury score (p=0.004) at day seven; hospital survival rates were similar between the two groups.
Moderate-dose corticosteroid use in additional populations at risk for acute respiratory distress syndrome: Subgroup analysis from one trial demonstrated that 28-day mortality was significantly reduced in non responding acute respiratory distress syndrome patients receiving treatment compared to controls (p=0.02). Another trial demonstrated significant improvements for a number of outcomes in patients with severe community-acquired pneumonia.