The ARDSNet just published the results of the Corticosteroid trial on the NEJM.
There was no mortality benefit and actually there was increased mortality in those started "late" on steroids.
Had you been using steroids on ARDS and/or is this new study going to change your practice?
Thursday, April 20, 2006
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5 comments - CLICK HERE to read & add your own!:
This is a long-awaited study. Steroids are out for both early and late ARDS since prelim results of this study were presented in ATS in 2004.I don't know why it took so long for them to publish the results.
I'm biased, but have not been (and will not be) using steroids for pure ARDS outside of a trial.
Jeff, I think now that's not being biased since there is data to support your position.
Just like early thinking with sepsis, steroids turns out not to be the panacea some had hoped they would be for the treatment of early, and now late ARDS. A month or so ago I acually did put someone int he late phase on steroids for 5 days. I think the NEJM study will make that action not likely in the future...
I think my decision is evidenced-based, but I do have an interest in the field of non-resolving ARDS, and I was biased before the data came out. Unfortunately, I think we'll hear a lot at ATS about how the story is not closed.
Some thoughts:
-20+ centers, over 7 years, enrolled 180 patients.
- During those 7 years, critical care has changed. I doubt the subgroup analyses are powered to detect differences attributable to all of these changes over time.
- How does one reconcile decreased ICU days, decreased MV days etc, with no difference in mortality? From an economic standpoint, we save money because the patients die outside of the ICU...
- On a positive note, the overall mortality (both 60 and 180 day) was around 30%. I think that reflects well on the overall improvement in critical care over the past decade. But, it probably has nothing to do with intervention directed at non-resolving ARDS.
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