Table 1.

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.