BMJ  2008;336:969-970 (3 May), doi:10.1136/bmj.39553.408924.80 (published 23 April 2008)

Editorials

Corticosteroids for acute respiratory distress syndrome

Avoid corticosteroids for prophylaxis; possibly use them for treatment

The first 150 words of the full text of this article appear below.

Acute respiratory distress syndrome (ARDS) is a major health problem, with the annual incidence in the United States approaching 200 000 cases.¹ In the accompanying paper, Peter and colleagues present a systematic review and meta-analysis of nine randomised controlled trials (1073 patients) of corticosteroids for prevention and treatment of ARDS.² ARDS is a form of severe respiratory failure resulting from direct pulmonary insults (for example, aspiration or pneumonia) or indirect systemic causes (for example, sepsis or trauma).³ This syndrome often has devastating consequences, such as the prolonged need for mechanical ventilation, a high probability of death, and long term physical and psychological sequelae in survivors. Treatment is unlikely to be successful in least developed countries because of limited critical care resources.⁴

No effective drug treatments are available for ARDS,⁵ but corticosteroids have attracted attention because they have anti-inflammatory properties that are relevant to ARDS pathology. They reduce both leakage of . . . [Full text of this article]

¹ Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada M4N 3M5

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