Meduri protocol steroids ards

Results  We identified 17 randomized trials (n = 2138) and 3 quasi-randomized trials (n = 246) that had acceptable methodological quality to pool in a meta-analysis. Twenty-eight-day mortality for treated vs control patients was 388/1099 (%) vs 400/1039 (%) in randomized trials (risk ratio [RR], ; 95% confidence interval [CI], -; P =.05; I 2 =53% by random-effects model) and 28/121 (%) vs 24/125 (%) in quasi-randomized trials (RR, , 95% CI, -; P  = .83). In 12 trials investigating prolonged low-dose corticosteroid treatment, 28-day mortality for treated vs control patients was 236/629 (%) vs 264/599 (44%) (RR, ; 95% CI, -; P  = .02). This treatment increased 28-day shock reversal (6 trials; 322/481 [%] vs 276/471 [%]; RR, ; 95% CI, -; P  = .02; I 2  = 4%) and reduced intensive care unit length of stay by days (8 trials; 95% CI, – to –; P  < .001; I 2  = 0%) without increasing the risk of gastroduodenal bleeding (13 trials; 65/800 [%] vs 56/764 [%]; P  = .50; I 2  = 0%), superinfection (14 trials; 184/998 [%] vs 170/950 [%]; P  = .92; I 2  = 8%), or neuromuscular weakness (3 trials; 4/407 [1%] vs 7/404 [%]; P  = .58; I 2  = 30%). Corticosteroids increased the risk of hyperglycemia (9 trials; 363/703 [%] vs 308/670 [46%]; P  < .001; I 2  = 0%) and hypernatremia (3 trials; 127/404 [%] vs 77/401 [%]; P  < .001; I 2  = 0%).

Results  One patient from the corticosteroid group was excluded from analyses because of consent withdrawal. There were 229 nonresponders to the corticotropin test (placebo, 115; corticosteroids, 114) and 70 responders to the corticotropin test (placebo, 34; corticosteroids, 36). In nonresponders, there were 73 deaths (63%) in the placebo group and 60 deaths (53%) in the corticosteroid group (hazard ratio, ; 95% confidence interval, -; P = .02). Vasopressor therapy was withdrawn within 28 days in 46 patients (40%) in the placebo group and in 65 patients (57%) in the corticosteroid group (hazard ratio, ; 95% confidence interval, -; P = .001). There was no significant difference between groups in responders. Adverse events rates were similar in the 2 groups.

Meduri GU, Golden E, Freire AX, et al. Methylprednisolone infusion in early severe ARDS: results of a randomized controlled trial. Chest 2007; 131:954-63. This study of 91 patients with severe ARDS added fuel to the debate over systemic corticosteroid use in ARDS. The intervention group received steroids within 72 hours of ARDS diagnosis and a slow taper. Steroid recipients had decreased duration of mechanical ventilation and ICU stay. The higher proportion of patients with catecholamine-dependent shock among controls, cross over from control to steroids in "nonresponders" at day 7, and 2:1 randomization of treatment to control are among the concerns raised since its publication.
PMID: 17426195
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Preface

Summary

1. Timeline

2. Virology

3. Transmission

4. Epidemiology

5. Prevention

6. Case Definition

7. Diagnostic Tests

8. Clinical Presentation and Diagnosis

9. SARS Treatment

10. Pediatric SARS



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9. SARS Treatment Loletta Kit-Ying SO ( Correspondence)
Arthur Chun-Wing LAU
Loretta Yin-Chun YAM The treatment of coronavirus-associated SARS has been evolving and so far there is no consensus on an optimal regimen. This chapter reviews the diverse treatment experience and controversies to date, and aims to consolidate our current knowledge and prepare for a possible resurgence of the disease.

Meduri protocol steroids ards

meduri protocol steroids ards

Preface

Summary

1. Timeline

2. Virology

3. Transmission

4. Epidemiology

5. Prevention

6. Case Definition

7. Diagnostic Tests

8. Clinical Presentation and Diagnosis

9. SARS Treatment

10. Pediatric SARS



Privacy

About


 
 
9. SARS Treatment Loletta Kit-Ying SO ( Correspondence)
Arthur Chun-Wing LAU
Loretta Yin-Chun YAM The treatment of coronavirus-associated SARS has been evolving and so far there is no consensus on an optimal regimen. This chapter reviews the diverse treatment experience and controversies to date, and aims to consolidate our current knowledge and prepare for a possible resurgence of the disease.

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