Table 1 The main characteristics of the randomized controlled trials
Study | No. of patients (steroids/control) | Subjects | Intervention | Treatment duration | Main outcomes |
|---|---|---|---|---|---|
Bernard/1987 | 50/49 | (1) Patients with PaO2 ≤ 70 mmHg (FiO2 ≥ 40%) or PaO2/PAO2 ≤ 0.3; (2) bilateral diffuse infiltrates on chest radiography; (3) PAWP ≤ 18 mmHg | Methylprednisolone 30 mg/kg IV every 6 h | 24 h | 45-day all-cause mortality |
Meduri/1998 | 16/8 | (1) patients diagnosed with ARDS by the AECC definition; (2) 7 days of mechanical ventilation with an LIS ≥ 2.5 and less than 1-point reduction from day 1 of ARDS; (3) no evidence of untreated inflection | Methylprednisolone 2 mg/kg bolus followed by 2 mg/kg (day 1–14), 1 mg/kg (day 15–21), 0.5 mg/kg (day 22–28),0.25 mg/day (day 28–32) | 32 days | Improvement in lung function and mortality |
Annane/2006 | 85/92 | (1) septic shock patients with bilateral infiltrates on chest radiography; (2) PaO2/FIO2 ≤ 200; (3) PAWP ≤ 18 mmHg or no clinical evidence of left atrial hypertension | Hydrocortisone 30 mg IV every 6 h and 9-fludrocortisone 50ug orally once a day | 7 days | 28-day survival |
Steinberg/2006 | 89/91 | (1) adult patients diagnosed with ARDS by the AECC definition; (2) patients were intubated and mechanically ventilated for 7–28 days after the onset of ARDS | Methylprednisolone 2 mg/kg bolus followed by 2 mg/kg (day 1–14), 1 mg/kg (day 15–21), tapering over (day 22–25) | 25 days | 60-day all-cause mortality |
Meduri/2007 | 63/28 | Adult intubated patients diagnosed with ARDS by the AECC definition | Methylprednisolone 1 mg/kg bolus followed by 1 mg/kg (day 1–14), 0.5 mg/kg (day 15–21), 0.125 mg/kg (day 22–25), 0.25 mg/day (day 26–28) | 28 days | A 1-point reduction in LIS or successful extubation by day 7 |
Rezk/2013 | 18/9 | (1) ARDS patients with PaO2/FIO2 < 200, bilateral pulmonary infiltrates, and PAWP < 18 mmHg; (2) patients were mechanically ventilated | Methylprednisolone 1 mg/kg bolus followed by 1 mg/kg (day 1–14), 0.5 mg/kg (day 15–21), 0.125 mg/kg (day 22–25), 0.25 mg/day (day 26–28) | 28 days | Improvements of clinical parameters |
Tongyoo/2016 | 98/99 | (1) Adult patients with severe sepsis or septic shock receiving mechanical ventilation; (2) patients diagnosed with ARDS by the AECC definition and the Berlin criteria | Hydrocortisone 50Â mg IV every 6Â h | 7Â days | 28-day all-cause mortality |
Villar/2020 | 139/138 | (1) Adult patients were intubated and mechanically ventilated; (2) patients diagnosed with ARDS by the AECC definition or the Berlin criteria as moderate to severe ARDS | Dexamethasone 20Â mg once daily from day 1 to day 5, which was reduced to 10Â mg once daily from day 6 to day 10 | 10Â days | Ventilator-free days during the first 28Â days |
Tomazini/2020 | 151/148 | (1) Adult patients with confirmed or suspected COVID-19 infection were receiving mechanical ventilation; (2) patients diagnosed with moderate to severe ARDS by the Berlin criteria | Dexamethasone 20Â mg daily from day 1 to day 5, followed by 10Â mg daily for 5Â days or until ICU discharge | 10Â days or until ICU discharge | Ventilator-free days during the first 28Â days |