Table 2

Published trials of short term, high dose steroid therapy in patients with ARDS

Author	No of patients	Diagnosis	Control group	Randomised	Prospective	Blinded	Methylprednisolone dose	Duration	Outcome
LIS=lung injury score; MODS=multiple organ dysfunction syndrome.
Meduri et al (1998)²⁸	24	Late ARDS	Yes	Yes	Yes	Yes	2 mg/kg load then 0.5 mg/kg 6 hrly reduced weekly to 1 mg/kg/day, 0.5 mg/kg/day then 0.15 mg/kg/day	32 days	Improvement in LIS, MODS, reduced mortality
Hooper et al (1996)⁷⁰	26	Established ARDS of >3 days with cause resolved	No	No	Yes	No	125–250 mg 6 hrly for 3–4 days reducing by 50% every 2–3 days		81% survival
Meduri et al (1995)⁷¹	9	Late ARDS	No	No	Yes	No	200 mg bolus, 2–3 mg/kg/day	Until extubation (average 6 weeks)	Reduction in plasma and BAL inflammatory cytokines
Biffl et al (1995)⁷²	6	Prolonged ARDS failing conventional therapy	No	No	Yes	No	1–2 mg/kg 6 hrly		83% survival; improved LIS and Pao₂/Fio₂
Meduri et al (1994)⁷³	25	Late ARDS	No	No	Yes	No	200 mg bolus, 2–3 mg/kg/day	Until extubation	Reduction in LIS, improved Pao₂/Fio₂
Meduri et al (1991)⁷⁴	8	Late ARDS	No	No	No	No	2 mg/kg bolus, 2–3 mg/kg 6 hrly	Until extubation	Reduction in LIS
Luce et al (1988)⁷⁵	75	Culture positive septic shock	Yes (mannitol placebo)	Yes	Yes	Yes	30 mg/kg 6 hrly	24 h	Terminated early after publication of ²⁶; no alteration in LIS
Bone et al (1987)²⁶	381	Severe sepsis and septic shock	Yes	Yes	Yes	Yes	30 mg/kg 6 hrly	24 h	No change in incidence of ARDS; mortality of ARDS higher; less frequent ARDS reversal
Bernard et al (1987)²⁵	99	ARDS	Yes	Yes	Yes	Yes	30 mg/kg 6 hrly	24 h	No mortality benefit
Weigelt et al (1985)²⁴	81	ARDS	Yes	Yes	Yes	Yes	30 mg/kg 6 hrly	48 h	No mortality benefit; increased infection rate
Lucas et al (1981)²³	114	Post-injury hypovolaemic shock lung	Yes	Yes	Yes		30 mg/kg 6 hrly	3 days	Increased mortality
Sladen (1976)²²	10	Shock lung	No	No	Yes	No	30 mg/kg 6 hrly	48 h	Improved mortality