Table 1.
The main characteristics of the randomized controlled trials
| Study | No. of patients (steroids/control) | Subjects | Intervention | Treatment duration | Main outcomes |
|---|---|---|---|---|---|
| Bernard/1987 | 50/49 | (1) Patients with PaO2 ≤ 70 mmHg (FiO2 ≥ 40%) or PaO2/PAO2 ≤ 0.3; (2) bilateral diffuse infiltrates on chest radiography; (3) PAWP ≤ 18 mmHg | Methylprednisolone 30 mg/kg IV every 6 h | 24 h | 45-day all-cause mortality |
| Meduri/1998 | 16/8 | (1) patients diagnosed with ARDS by the AECC definition; (2) 7 days of mechanical ventilation with an LIS ≥ 2.5 and less than 1-point reduction from day 1 of ARDS; (3) no evidence of untreated inflection | Methylprednisolone 2 mg/kg bolus followed by 2 mg/kg (day 1–14), 1 mg/kg (day 15–21), 0.5 mg/kg (day 22–28),0.25 mg/day (day 28–32) | 32 days | Improvement in lung function and mortality |
| Annane/2006 | 85/92 | (1) septic shock patients with bilateral infiltrates on chest radiography; (2) PaO2/FIO2 ≤ 200; (3) PAWP ≤ 18 mmHg or no clinical evidence of left atrial hypertension | Hydrocortisone 30 mg IV every 6 h and 9-fludrocortisone 50ug orally once a day | 7 days | 28-day survival |
| Steinberg/2006 | 89/91 | (1) adult patients diagnosed with ARDS by the AECC definition; (2) patients were intubated and mechanically ventilated for 7–28 days after the onset of ARDS | Methylprednisolone 2 mg/kg bolus followed by 2 mg/kg (day 1–14), 1 mg/kg (day 15–21), tapering over (day 22–25) | 25 days | 60-day all-cause mortality |
| Meduri/2007 | 63/28 | Adult intubated patients diagnosed with ARDS by the AECC definition | Methylprednisolone 1 mg/kg bolus followed by 1 mg/kg (day 1–14), 0.5 mg/kg (day 15–21), 0.125 mg/kg (day 22–25), 0.25 mg/day (day 26–28) | 28 days | A 1-point reduction in LIS or successful extubation by day 7 |
| Rezk/2013 | 18/9 | (1) ARDS patients with PaO2/FIO2 < 200, bilateral pulmonary infiltrates, and PAWP < 18 mmHg; (2) patients were mechanically ventilated | Methylprednisolone 1 mg/kg bolus followed by 1 mg/kg (day 1–14), 0.5 mg/kg (day 15–21), 0.125 mg/kg (day 22–25), 0.25 mg/day (day 26–28) | 28 days | Improvements of clinical parameters |
| Tongyoo/2016 | 98/99 | (1) Adult patients with severe sepsis or septic shock receiving mechanical ventilation; (2) patients diagnosed with ARDS by the AECC definition and the Berlin criteria | Hydrocortisone 50 mg IV every 6 h | 7 days | 28-day all-cause mortality |
| Villar/2020 | 139/138 | (1) Adult patients were intubated and mechanically ventilated; (2) patients diagnosed with ARDS by the AECC definition or the Berlin criteria as moderate to severe ARDS | Dexamethasone 20 mg once daily from day 1 to day 5, which was reduced to 10 mg once daily from day 6 to day 10 | 10 days | Ventilator-free days during the first 28 days |
| Tomazini/2020 | 151/148 | (1) Adult patients with confirmed or suspected COVID-19 infection were receiving mechanical ventilation; (2) patients diagnosed with moderate to severe ARDS by the Berlin criteria | Dexamethasone 20 mg daily from day 1 to day 5, followed by 10 mg daily for 5 days or until ICU discharge | 10 days or until ICU discharge | Ventilator-free days during the first 28 days |
ARDS acute respiratory distress syndrome, PaO2 partial pressure of oxygen in arterial blood, PAO2 partial pressure of alveolar oxygen, FiO2 fraction of inspired oxygen, PAWP pulmonary artery wedge pressure, AECC the American-European Consensus Conference criteria, LIS lung injury score, COVID-19 coronavirus disease 2019, ICU intensive care unit, IV intravenous, h hour(s)