Corticosteroids in acute respiratory distress syndrome: a step forward, but more evidence is needed

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Debate continues about the potential role of corticosteroids as therapy for acute respiratory distress syndrome (ARDS). 1 Meduri GU Siemieniuk RAC Prolonged glucocorticoid treatment in acute respiratory distress syndrome. Lancet. 2017; 3891516 Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar , 2 Sweeney RM McAuley DF Acute respiratory distress syndrome. Lancet. 2016; 388: 2416-2430 Summary Full Text Full Text PDF PubMed Scopus (197) Google Scholar , 3 Sweeney RM McAuley DF Prolonged glucocorticoid treatment in acute respiratory distress syndrome–Authors' reply. Lancet. 2017; 389: 1516-1517 Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar In The Lancet Respiratory Medicine, Jesús Villar and colleagues 4 Villar J Ferrando C Martínez D et al. Dexamethasone treatment for acute respiratory distress syndrome: a mutlicentre, randomised controlled trial. Lancet Respir Med. 2020; (published online Feb 7.)https://doi.org/10.1016/S2213-2600(19)30417-5 Summary Full Text Full Text PDF PubMed Scopus (310) Google Scholar report the results from a multicentre, open-label, randomised controlled trial investigating prolonged dexamethasone treatment in patients with established moderate-to-severe ARDS, which adds important new data to this debate. In this study, patients in the dexamethasone group had reduced duration of ventilation and mortality compared with those in the control group; 4 Villar J Ferrando C Martínez D et al. Dexamethasone treatment for acute respiratory distress syndrome: a mutlicentre, randomised controlled trial. Lancet Respir Med. 2020; (published online Feb 7.)https://doi.org/10.1016/S2213-2600(19)30417-5 Summary Full Text Full Text PDF PubMed Scopus (310) Google Scholar the primary outcome, ventilator-free days at 28 days, was increased by 4·8 days (95% CI 2·57 to 7·03; p<0·0001) and mortality at 60 days after randomisation decreased by 15·3% (−25·9 to −4·9; p=0·0047). Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trialEarly administration of dexamethasone could reduce duration of mechanical ventilation and overall mortality in patients with established moderate-to-severe ARDS. Full-Text PDF