Meduri 1998

Methods	n = 24, 4 centres Allocation concealment: not described Baseline similarity: age, MODS, sepsis; analyses adjusted for variables used to calculate severity of illness scores Blinding: caregivers Cointerventions: lung protective ventilation (limitation of plateau pressure to 35 cmH20) used in both groups Withdrawals: none Losses to follow‐up: none
Participants	Inclusions: AECC definition for ARDS; at least 7 days of mechanical ventilation; lung injury score at least 2.5 with a reduction of less than 1 point from day 1 of ARDS Exclusions: ARDS of 3 or more weeks' duration; untreated infection; burns; recent gastrointestinal bleed
Interventions	IV methylprednisolone, 2 mg/kg/day IV for 14 days, tapering to zero over the next 18 days, or placebo
Outcomes	ICU mortality: 0/16 (methylprednisolone group) and 5/8 (placebo group); RR 0.05 (95% CI 0 to 0.78) Hospital mortality: 2/16 (methylprednisolone group) and 5/8 (placebo group); RR 0.20 (95% CI 0.05 to 0.81) Duration of ventilation (median days): 11.5 (methylprednisolone group); 23 (placebo group); p = 0.001 Adverse events leading to discontinuation of therapy not reported Other safety data: infections per 100 patient‐days of treatment: 8 (methylprednisolone group); 7 (placebo group)
Notes	The mean duration of ARDS at randomization was 9.4 days (standard error 0.9 days) in the methyprednisolone group and 8.8 days (standard error 1.2 days) in the placebo group.
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear