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April 9, 2007

Methylprednisolone Infusion in Early Severe ARDS

Lara Samkary

Summarized by: 

What was the research question?

  • Does low-dose extended methylprednisolone infusion improve lung function in patients with early severe ARDS (72 h), as indicated by a 1-point reduction in lung injury score (LIS) or successful extubation by day 7?

How did they do it?

  • The study is a randomized, double-blind, placebo-controlled trial, carried out in the intensive care units of five Memphis hospitals.

  • The study included 91 patients with early severe ARDS (72 h), with 66% additionally having sepsis.

  • Using a 2:1 randomization protocol, patients were assigned into the methylprednisone infusion group (63) and placebo group (28).

  • The key outcome measures were a 1-point decrease in the lung injury score (LIS) or successful extubation by day 7. C-reactive protein levels, mechanical ventilation duration, ICU stay, ICU mortality, multiple organ dysfunction syndrome scores, and infection rates were all secondary outcome measures.

What did they find?

  • In in comparison to the control group, the methylprednisolone-treated group had a substantially larger proportion of patients with a 1-point reduction in lung injury score (LIS) by day 7 (69.8% vs 35.7%, p 0.002).

  • By day 7, the methylprednisolone-treated group had a higher proportion of patients breathing without assistance versus the control group (54.0% vs 25.0%, p 0.01).

  • Secondary outcomes were also significantly better in the treatment group vs the control group. They were associated with lower CRP levels and MODS scores.

  • The duration of ICU stays was shorter, and mortalities lower in the treatment group, (7 vs 14.5 days, p = 0.007) and (20.6% vs 42.9%, p = 0.03) respectively.

  • Infections were less prevalent in treated patients (15.9% vs 28.6%, p = 0.0002).

What are the limitations?

  • The study's small sample size may have an impact on the findings' generalizability and reliability.

  • The presence of imbalances among patients with catecholamine-dependent shock may introduce bias and affect the accuracy of estimating the therapeutic effect on mortality.

  • The accuracy of the assessments in this study may be hampered by previously described problems in evaluating chest radiographs in individuals with acute respiratory distress syndrome (ARDS).

What does it mean?

  • In patients with early severe ARDS, low-dose extended methylprednisolone infusion was linked with significant improvement in pulmonary and extrapulmonary organ dysfunction, shortened time of mechanical ventilation, and lower ICU mortality and infection rates.

  • The findings indicate that low-dose prolonged methylprednisolone infusion may be useful in the management of early severe ARDS, potentially increasing lung function and improving patient outcomes. More research is required to confirm these findings and analyze the long-term implications.


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