A Comparative Study of Glucocorticoids Efficacy in Acute Respiratory Distress Syndrome

TL;DR

This study compares three glucocorticoids in treating ARDS and finds methylprednisolone to be most effective in reducing mortality and hospital stays.

Contribution

The study provides a direct comparison of methylprednisolone, hydrocortisone, and dexamethasone at equivalent doses in ARDS patients.

Findings

Methylprednisolone showed the lowest mortality rate among the three glucocorticoids.

Dexamethasone had the highest PaO2/FiO2 and SpO2/FiO2 ratios at follow-up.

Methylprednisolone reduced ICU and hospital durations more effectively than the other drugs.

Abstract

Background: Acute respiratory distress syndrome (ARDS), recognized as an inflammatory and life-threatening lung injury, is typified by severe hypoxaemia, lack of heart-related pulmonary edema, and bilateral lung infiltrates. Glucocorticoids are anti-inflammatory and immunoregulatory agents that are considered a viable treatment for ARDS. This study sought to contrast the effects of methylprednisolone, hydrocortisone, and dexamethasone at equivalent doses in ARDS. Methods: About 195 ARDS patients were allocated at random to take methylprednisolone (1 mg/kg/day), hydrocortisone (350 mg/day), or dexamethasone (13 mg/day). The primary and secondary outcomes over 28 days following the initiation of glucocorticoid therapy involved mortality, ventilator-free days, duration of hospitalization, duration of intensive care unit (ICU), total number of patients requiring invasive mechanical ventilation, and changes in the means of arterial oxygen partial pressure to inspired oxygen fraction (PaO2/FiO2) and oxygen saturation percentage to inspired oxygen fraction (SpO2/FiO2) ratios. Results: Over the 28-day follow-up, regarding mortality, there was a significant difference between dexamethasone and hydrocortisone, as well as between methylprednisolone and hydrocortisone. However, methylprednisolone exhibited the lowest mortality. There were no significant differences among study groups in ventilator-free days, hospitalization duration, ICU duration, and requirement for invasive mechanical ventilation. On the other hand, methylprednisolone had the lowest means of both durations of hospitalization and ICU, and the lowest requirement for invasive mechanical ventilation. Each study group exhibited a significant increase in both PaO2/FiO2 and SpO2/FiO2 ratios at follow-up time. However, dexamethasone showed the highest means of both PaO2/FiO2 and SpO2/FiO2 ratios at follow-up time. There was a significant difference in PaO2/FiO2 and SpO2/FiO2 ratios at follow-up assessment between dexamethasone and hydrocortisone. Conclusions: At equivalent doses, treating ARDS with methylprednisolone may be more successful than using dexamethasone and hydrocortisone.

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