Argument against the Routine Use of Steroids for Pediatric Acute Respiratory Distress Syndrome.

Silvia M Hartmann,Catherine L Hough

doi:10.3389/fped.2016.00079

Abstract

Steroids have a plausible mechanism of action of reducing severity of lung disease in acute respiratory distress syndrome (ARDS) but have failed to show consistent benefits in patient-centered outcomes. Many studies have confounding from the likely presence of ventilator-induced lung injury and steroids may have shown benefit because administration minimized ongoing inflammation incited by injurious ventilator settings. If steroids have benefit, it is likely for specific populations that fall within the heterogeneous diagnosis of ARDS. Those pediatric patients with concurrent active asthma or reactive airway disease of prematurity, in addition to ARDS, are the most common group likely to derive benefit from steroids, but are poorly studied. With the information currently available, it does not appear that the typical adult or pediatric patient with ARDS derives benefit from steroids and steroids should not be given on a routine basis.

Highlights

It is widely accepted among intensivists that dysregulated inflammation in response to an inciting infection or injury is a key pathophysiologic feature of acute respiratory distress syndrome (ARDS)
The summative evidence for steroid administration to the patient with ARDS or pediatric ARDS (PARDS) falls short of the level needed to support routine use for either early or late disease
The positive signal for steroids in some studies combined with higher likelihood of benefit in some subgroups, such as those with steroid-responsive underlying disorders, supports ongoing research into the appropriate use of steroids for ARDS

Summary

Argument against the Routine Use of Steroids for Pediatric Acute

Steroids have a plausible mechanism of action of reducing severity of lung disease in acute respiratory distress syndrome (ARDS) but have failed to show consistent benefits in patient-centered outcomes. It is likely for specific populations that fall within the heterogeneous diagnosis of ARDS. Those pediatric patients with concurrent active asthma or reactive airway disease of prematurity, in addition to ARDS, are the most common group likely to derive benefit from steroids, but are poorly studied. With the information currently available, it does not appear that the typical adult or pediatric patient with ARDS derives benefit from steroids and steroids should not be given on a routine basis

INTRODUCTION

MINIMIZE PULMONARY INFLAMMATION

INHIBIT FIBROPROLIFERATION

OF STEROID TREATMENT FOR ARDS

Findings

CONCLUSION