Monday April 30, 2007
Glucocorticoids in early ARDS - a must read study !
- Maduri is back !!
A very important study published in April 2007 issue of chest 3, from guru of glucocorticoids in ARDS, Dr. Maduri. Earlier he proposed role of glucocorticoids in late ARDS 1 (which was recently negated by ARDSnet LaSRS trial 2).
This study is about - Methylprednisolone Infusion in Early Severe ARDS and showed very promising results.
- The 2:1 randomization trial ( (63 treated and 28 control) was conducted with
- a loading dose of 1 mg/kg, followed by
- an infusion of 1 mg/kg/d from day 1 to day 14,
- 0.5 mg/kg/d from day 15 to day 21,
- 0.25 mg/kg/d from day 22 to day 25, and
- 0.125 mg/kg/d from day 26 to day 28.
If the patient was extubated between days 1 and 14, the patient was advanced to day 15 of drug therapy and tapered according to schedule. Please refer to full article for further components of study including ventilator guidelines, no use of neuromuscular blockers and periodic bronchoscopy.
Results: The response of the two groups (63 treated and 28 control) clearly diverged by day 7, with twice the proportion of treated patients achieving
- a 1-point reduction in Lung Injury Score - LIS (69.8% vs 35.7%; p = 0.002)
breathing without assistance (53.9% vs 25.0%; p = 0.01). - significant reduction in C-reactive protein levels,
- by day 7 had lower multiple organ dysfunction syndrome scores
- a reduction in the duration of mechanical ventilation (p = 0.002),
- ICU stay (p = 0.007)
- ICU mortality (20.6% vs 42.9%; p = 0.03) and
- a lower rate of infections (p = 0.0002).
Editors' comment: We stronly encourage all intensivists to read this study along with editorial written in the same issue by Dr. Djillali Annane endorsing the above protocol
Reference: click to get abstract
1. Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome: a randomized controlled trial. JAMA 1998;280,159-165
2. Efficacy and Safety of Corticosteroids for Persistent Acute Respiratory Distress Syndrome - , New Engl J Med, April 20, Volume 354, Issue 16, p.1671-1684, (2006)
3. Methylprednisolone Infusion in Early Severe ARDS*Results of a Randomized Controlled Trial - Chest. 2007; 131:954-963
4. Glucocorticoids for ARDS: Just Do It! - Djillali Annane Chest Apr 2007: 945–946.
49 comments:
It is an intersting study, but I think it has serious problem with randomization - statisticaly higher proprtion of patients with catecholamine dependent shock in the control group.
We need larger better randomized trial.
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