From the Department of Pharmacy, Hubei Provincial Hospital of Traditional Chinese Medicine/Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China.
From the Department of Respiratory Medicine, Hubei Provincial Hospital of Traditional Chinese Medicine/Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China.
Ann Saudi Med. 2024 May-Jun;44(3):167-182. doi: 10.5144/0256-4947.2024.167. Epub 2024 Jun 6.
Acute respiratory distress syndrome (ARDS), which results in lung injury as a consequence of sepsis and septic shock, is associated with severe systemic inflammation and is responsible for a high worldwide mortality rate.
Investigate whether corticosteroids could benefit clinical outcomes in adult with ARDS.
A comprehensive search of electronic databases Ovid MEDLINE, Ovid EMbase, and Cochrane Library from their inception to 7 May 2023 was conducted to identify studies that met the eligibility criteria, including only randomized controlled trials. The study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the methods of trial sequential analysis.
Mortality rates, including including the 14-, 28-, 45-, and 60-day mortality, hospital mortality, and intensive care unit (ICU) mortality.
17 studies with 2508 patients.
Data relating to mortality at 14, 28, 45, and 60 days were not significantly different when treatments with corticosteroids and placebo were compared. In terms of hospital and ICU mortality, the mortality of those who had received corticosteroids was significantly lower than that of those who had not. ARDS patients who received assisted ventilation benefited from corticosteroid therapy, as revealed by the significant difference in outcome days between those who received assisted ventilation and those who did not. Corticosteroid had significantly more days free from mechanical ventilation, ICU-free days, and MODS-free days during the first 28 days, but not more organ support-free days up to day 28.
Although corticosteroid therapy did not reduce mortality rates at different observation periods, it significantly reduced hospital and ICU mortality. Administering corticosteroids to ARDS patients significantly decreased the days of assisted ventilation and time cost consumption. This study confirmed that long-term use of low-dose glucocorticoids may have a positive effect on early ARDS.
Risk of bias due to the differences in patient characteristics.
急性呼吸窘迫综合征（ARDS）是由脓毒症和感染性休克导致的肺损伤，其与严重的全身炎症有关，且全球病死率居高不下。
探讨全身应用皮质激素是否对 ARDS 成人患者的临床结局有益。
通过对 Ovid MEDLINE、Ovid EMbase 和 Cochrane Library 电子数据库进行全面检索，检索时间从建库至 2023 年 5 月 7 日，以确定符合纳入标准的研究，仅纳入随机对照试验。研究遵循系统评价和荟萃分析的 Preferred Reporting Items（PRISMA）指南和试验序贯分析方法。
死亡率，包括 14 天、28 天、45 天和 60 天死亡率、住院死亡率和重症监护病房（ICU）死亡率。
17 项研究共 2508 例患者。
与安慰剂相比，皮质激素治疗与死亡率在 14、28、45 和 60 天无显著差异。在住院和 ICU 死亡率方面，皮质激素组死亡率显著低于未用皮质激素组。接受辅助通气的 ARDS 患者从皮质激素治疗中获益，表现为接受辅助通气和未接受辅助通气患者的预后天数有显著差异。皮质激素在第 1 个 28 天内机械通气天数、无 ICU 天数和无 MODS 天数明显增加，但 28 天内无器官支持天数没有明显增加。
尽管皮质激素治疗未降低不同观察期的死亡率，但显著降低了住院和 ICU 死亡率。皮质激素治疗 ARDS 患者可显著减少辅助通气天数和时间消耗。本研究证实，长期使用小剂量糖皮质激素可能对早期 ARDS 有积极作用。
由于患者特征存在差异，存在偏倚风险。
