Table 2

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

AuthorNo of patientsDiagnosisControl groupRandomisedProspectiveBlindedMethylprednisolone doseDurationOutcome
LIS=lung injury score; MODS=multiple organ dysfunction syndrome.
Meduri et al (1998)2824Late ARDSYesYesYesYes2 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/day32 daysImprovement in LIS, MODS, reduced mortality
Hooper et al (1996)7026Established ARDS of >3 days with cause resolvedNoNoYesNo125–250 mg 6 hrly for 3–4 days reducing by 50% every 2–3 days81% survival
Meduri et al (1995)719Late ARDSNoNoYesNo200 mg bolus, 2–3 mg/kg/dayUntil extubation (average 6 weeks)Reduction in plasma and BAL inflammatory cytokines
Biffl et al (1995)726Prolonged ARDS failing conventional therapyNoNoYesNo1–2 mg/kg 6 hrly83% survival; improved LIS and Pao2/Fio2
Meduri et al (1994)7325Late ARDSNoNoYesNo200 mg bolus, 2–3 mg/kg/dayUntil extubationReduction in LIS, improved Pao2/Fio2
Meduri et al (1991)748Late ARDSNoNoNoNo2 mg/kg bolus, 2–3 mg/kg 6 hrlyUntil extubationReduction in LIS
Luce et al (1988)7575Culture positive septic shockYes (mannitol placebo)YesYesYes30 mg/kg 6 hrly24 hTerminated early after publication of 26; no alteration in LIS
Bone et al (1987)26381Severe sepsis and septic shockYesYesYesYes30 mg/kg 6 hrly24 hNo change in incidence of ARDS; mortality of ARDS higher; less frequent ARDS reversal
Bernard et al (1987)2599ARDSYesYesYesYes30 mg/kg 6 hrly24 hNo mortality benefit
Weigelt et al (1985)2481ARDSYesYesYesYes30 mg/kg 6 hrly48 hNo mortality benefit; increased infection rate
Lucas et al (1981)23114Post-injury hypovolaemic shock lungYesYesYes30 mg/kg 6 hrly3 daysIncreased mortality
Sladen (1976)2210Shock lungNoNoYesNo30 mg/kg 6 hrly48 hImproved mortality