ARDS: no pharmacological class carries significant benefit in Cochrane review

  • Lewis SR & al.
  • Cochrane Database Syst Rev
  • 23 Jul 2019

  • International Clinical Digest
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Takeaway

  • 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%.

Study design

  • 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

Key results

  • 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.

Limitations

  • Low certainty of evidence according to GRADE criteria.