- A Cochrane review finds that no pharmacological class carries significant benefits for acute respiratory distress syndrome (ARDS).
- The only class that may help is corticosteroids; beta-agonists may harm, and others appear to have no effect.
Why this matters
- Mortality from ARDS is about 40%.
- Analysis and meta-analysis of 48 randomized controlled trials (RCTs; with placebo or standard therapy) after search including CENTRAL, MEDLINE, EMBASE, and CINAHL.
- Most frequent outcome was early mortality (≤3 months).
- Funding: National Institute for Health Research
- Corticosteroids vs controls:
- Early mortality may be reduced (risk ratio [RR], 0.77; 95% CI, 0.57-1.05).
- Late mortality (>3 months; RR, 0.99; 95% CI, 0.64-1.52).
- Duration of mechanical ventilation (mean difference [MD], −4.30 [95% CI, −9.72 to 1.12] days).
- Ventilator-free days up to day 28 (VFD) may be improved (MD, 4.09; 95% CI, 1.74-6.44).
- Beta-agonists vs controls:
- Early mortality may be slightly increased (RR, 1.14; 95% CI, 0.91-1.42).
- VFD may be fewer (MD, −2.20; 95% CI, −3.68 to −0.71).
- No significant benefits/harms from 3 other classes/agents: surfactants vs controls, N-acetylcysteine vs placebo, or statins vs placebo.
- Low certainty of evidence according to GRADE criteria.