Department of Respiratory Medicine, Chongqing Qianjiang Central Hospital, Chongqing, China.
Department of Critical Care Medicine, Chongqing Qianjiang Central Hospital, Chongqing, China.
Medicine (Baltimore). 2022 Sep 30;101(39):e30195. doi: 10.1097/MD.0000000000030195.
This meta-analysis aimed to evaluate the efficacy and safety of dexamethasone in the treatment of acute respiratory distress syndrome (ARDS).
A systematic search of electronic databases was carried out from inception to May 1, 2022, including PUBMED, EMBASE, Cochrane Library, Wangfang, VIP, and CNKI. Other searches were also checked for dissertations/theses and the reference lists of the included studies. Two team members examined all citations and selected eligible articles. Randomized controlled trials (RCTs) reporting the efficacy and safety of dexamethasone for the treatment of ARDS were included, and the quality of eligible RCTs was assessed using the Cochrane Risk of Bias Tool. If necessary, we conducted data synthesis and meta-analysis. The primary outcome was all-cause mortality. Secondary outcomes were mechanical ventilation duration (day), ventilator-free status at 28 days; intensive care unit (ICU) free (day), ICU mortality, hospital mortality, sequential organ failure assessment (SOFA) as mean and range, SOFA as No. of patients, peak airway pressure (cmH2O), arterial oxygen pressure (mm Hg), days with PaO2 > 10kPa, PaO2, and the occurrence rate of adverse events.
Four studies involving 702 patients were included in this analysis. This study showed that dexamethasone could significantly reduce all-cause mortality (odds ratio (OR) = 0.62, 95% confidence interval (CI) [0.44, 0.88], I2 = 30%, P < .001), and decrease ventilator-free status at 28 days (MD = 3.65, 95% CI [1.49, 5.80], I2 = 51%, P < .001). No significant differences in occurrence rates of adverse events were found between dexamethasone and routine or standard care.
Evidence from the meta-analysis suggests that dexamethasone is an effective and relatively safe treatment for all-cause mortality and ventilator-free status at 28 days in patients with ARDS. Owning to the small number of eligible RCTs, the conclusions of present study are warranted in the future study.
本荟萃分析旨在评估地塞米松治疗急性呼吸窘迫综合征（ARDS）的疗效和安全性。
从建库至 2022 年 5 月 1 日，系统检索了 PUBMED、EMBASE、Cochrane 图书馆、万方、VIP 和中国知网等电子数据库，并检索了其他可能的文献以获取论文和纳入研究的参考文献列表。两名研究人员检查了所有引用文献，并选择了合格的文章。纳入了报告地塞米松治疗 ARDS 的疗效和安全性的随机对照试验（RCT），并使用 Cochrane 偏倚风险工具评估合格 RCT 的质量。如有必要，我们进行了数据综合和荟萃分析。主要结局为全因死亡率。次要结局为机械通气时间（天）、28 天无呼吸机状态；重症监护病房（ICU）无（天）、ICU 死亡率、医院死亡率、序贯器官衰竭评估（SOFA）平均值和范围、SOFA 患者数、气道峰压（cmH2O）、动脉血氧分压（mmHg）、PaO2 > 10kPa 天数、PaO2 及不良事件发生率。
本分析纳入了四项涉及 702 名患者的研究。本研究表明，地塞米松可显著降低全因死亡率（比值比（OR）=0.62，95%置信区间（CI）[0.44, 0.88]，I2=30%，P<.001），并降低 28 天无呼吸机状态（MD=3.65，95%CI[1.49, 5.80]，I2=51%，P<.001）。地塞米松与常规或标准治疗的不良事件发生率无显著差异。
荟萃分析的证据表明，地塞米松治疗 ARDS 患者的全因死亡率和 28 天无呼吸机状态是有效且相对安全的。由于合格 RCT 数量较少，本研究的结论需要在未来的研究中进一步验证。
