Corticosteroids compared to placebo for ARDS
| Patient or population: adults with ARDS Settings: intensive care Intervention: corticosteroids Comparison: placebo | ||||||
| Outcomes | Illustrative comparative risks (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of evidence (GRADE) | Comments | |
| Control risk | Intervention risk | |||||
| Placebo | Corticosteroids | |||||
| Mortality (hospital) | 526 per 1000 | 326 per 1000 (121 to 663) | RR 0.62 (0.23 to 1.26) | 561 (five studies) | +--- VERY LOW Due to serious risk of bias, serious inconsistency and serious imprecision | All studies conducted in the prelung protection strategy era. One study changed ventilation protocol during the study, following ARDS Net ARMA result |
| Mortality (hospital or 60 day) | 500 per 1000 | 455 per 1000 (355 to 590) | RR 0.91 (0.71 to 1.18) | 725 (eight studies) | ++-- LOW Due to serious inconsistency and serious imprecision | Pooled estimate from studies of both treatment and preventative steroids |
| Adverse events | 350 per 1000 | 287 per 1000 (175 to 477) | RR 0.82 (0.5 to 1.36) | 494 (four studies) | ++-- LOW Due to serious risk of bias and serious imprecision | Composite of infection; neuromyopathy; diabetes, gastrointestinal bleeding and others |
| Adverse event: post-ICU cognitive function | Mean—74.31 | Mean—10.71 higher (5.22 higher to 16.2 higher) | 100 (one study) | +--- VERY LOW Due to very serious risk of bias and serious indirectness | Assessed with: cognitive function component of QLQ-C30 Scale from: 0 to 100, with a higher score representing better cognitive function | |
ARDS, acute respiratory distress syndrome; ICU, intensive care unit.