Yoshihro Shodai, Taito Shunsuke, Yatabe Tomoaki
Department of Pharmaceutical Services, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
J Intensive Care. 2023 Jul 10;11(1):32. doi: 10.1186/s40560-023-00681-4.
Recent systematic reviews and meta-analyses have suggested that low-dose steroids are effective in the treatment of acute respiratory distress syndrome (ARDS). Recent guidelines recommend the use of low-dose steroids instead of high-dose steroids. These systematic reviews were conducted based on the concept that the effect of steroids is constant regardless of their type. We discuss whether the type of steroid used influences the outcomes in patients with ARDS.
From a pharmacological standpoint, methylprednisolone has little activity as a mineralocorticoid and may cause pulmonary hypertension. The results of the rank probability of our previous network meta-analysis revealed that low-dose methylprednisolone might be an optimal treatment compared to using other types of steroids or no steroids in terms of ventilator-free days. Similarly, an analysis of individual data from four randomized controlled trials suggested that low-dose methylprednisolone was associated with decreased mortality in patients with ARDS. Dexamethasone has attracted the attention of clinicians as a novel adjunct therapy for ARDS.
Recent evidence has shown that low-dose methylprednisolone may be an effective treatment option for ARDS. The timing of initiation and duration of low-dose methylprednisolone therapy should be verified in future studies.
近期的系统评价和荟萃分析表明，低剂量类固醇对急性呼吸窘迫综合征（ARDS）有效。近期指南推荐使用低剂量类固醇而非高剂量类固醇。这些系统评价是基于类固醇的效果与其类型无关这一概念进行的。我们探讨了所使用的类固醇类型是否会影响ARDS患者的治疗结果。
从药理学角度来看，甲泼尼龙作为盐皮质激素活性较低，可能会导致肺动脉高压。我们之前网络荟萃分析的排序概率结果显示，就无呼吸机天数而言，与使用其他类型类固醇或不使用类固醇相比，低剂量甲泼尼龙可能是一种最佳治疗方法。同样，对四项随机对照试验的个体数据进行分析表明，低剂量甲泼尼龙与ARDS患者死亡率降低相关。地塞米松作为ARDS的一种新型辅助治疗方法已引起临床医生的关注。
近期证据表明，低剂量甲泼尼龙可能是ARDS的一种有效治疗选择。低剂量甲泼尼龙治疗的起始时机和持续时间应在未来研究中加以验证。
