Health and Suppliments

According to new results from the ARDS Clinical Research Network of the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, corticosteroids do not prove effective when it comes to improving the survival rate in patients with ARDS (acute respiratory distress syndrome).

This study is the first-of-its-kind multi-center randomized clinical trial for evaluating the effects of moderate doses of steroids in patients fighting with ARDS when the relevant treatment is initiated 7 days or more after onset of the condition.

From News-Medical.Net:

Because ARDS is related to inflammation in the lung, steroids are sometimes used in the hopes of helping the lungs heal. Earlier small or observational studies have suggested that moderate doses of steroids given 7 or more days after the onset of ARDS might improve lung function and increase survival. But a larger randomized clinical trial – considered the gold standard in medical research – was needed to determine whether moderate doses of steroids are beneficial for patients with late-stage ARDS.

The new study began in 1997 and involved 180 patients and researchers from 25 hospitals in the U.S. Eligible ARDS patients who had been on mechanical ventilators for 7 to 28 days were randomly selected to receive either a moderate dose of methylprednisolone sodium succinate or placebo intravenously. They were followed for 180 days. Patients or their surrogates provided informed consent to participate in the study.

Overall, there was no difference in mortality at 60 days or 180 days between patients treated with steroids and those who were not treated with steroids. However, when researchers reviewed the data for a small subgroup (23) of patients who began steroid treatment after two weeks or more of ARDS, they found that these participants had a significantly higher risk of death at 60 days and at 180 days than a comparable number in the control group. Although the effect of steroids on survival was linked to how long the patients had ARDS before starting treatment, the researchers report that it remains unclear if there is optimal timing for steroid treatment during the course of ARDS.

Whether the positive effects of moderate doses of steroids seen in some of the patients with ARDS outweigh the risks of neuromuscular complications is an issue that patients, their families, and physicians need to grapple with, as per Gordon Bernard, MD, director of the Division of Allergy, Pulmonary and Critical Care Medicine at Vanderbilt University in Nashville, and chair of the Steering Committee for the NHLBI ARDS Clinical Research Network.

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