Prolonged low-dose methylprednisolone treatment is highly effective in reducing duration of mechanical ventilation and mortality in patients with ARDS

Table 1 Methylprednisolone treatment of early moderate-to-severe ARDS and late unresolving ARDS

Early moderate-to-severe ARDS (PaO₂:FiO₂ ≤ 200 on PEEP 5 cmH₂0)
Time	Intravenous administration form	Dosage
Loading	Bolus over 30 min	1 mg/kg
Days 1 to 14*^,†,‡	Infusion at 10 cc/hour	1 mg/kg/day
Days 15 to 21*^,‡	Infusion at 10 cc/hour	0.5 mg/kg/day
Days 22 to 25*^,‡	Infusion at 10 cc/hour	0.25 mg/kg/day
Days 26 to 28*^,‡	Infusion at 10 cc/hour	0.125 mg/kg/day
Unresolving ARDS = less than (a) one-point reduction in lung injury score or (b) or 100 improvement of in PaO₂:FiO₂ • By day 7 of ARDS in patients not receiving methylprednisolone for early ARDS • By days 5–7 of ARDS in patients receiving methylprednisolone (above) for early ARDS
Time	Intravenous administration form	Dosage
Loading	Bolus over 30 min	2 mg/kg
Days 1 to 14*^,†,‡	Infusion at 10 cc/hour	2 mg/kg/day
Days 15 to 21*^,‡	Infusion at 10 cc/hour	1 mg/kg/day
Days 22 to 25*^,‡	Infusion at 10 cc/hour	0.5 mg/kg/day
Days 26 to 28*^,‡	Infusion at 10 cc/hour	0.25 mg/kg/day
Days 29 to 28*^,‡	Bolus over 30 min	0.125 mg/kg/day

IV = intravenous. The dosage is adjusted to ideal body weight and round up to the nearest 10 mg (i.e., 77 mg round up to 80 mg). The bolus is given over 30 min. The infusion is obtained by adding the daily dosage to 240 cc of normal saline and run at 10 cc/hour
*Five days after the patient can ingest medications, methylprednisolone is administered per os in one single daily equivalent dose. Enteral absorption of methylprednisolone is compromised for days after extubation. Prednisone (available in 1-mg, 5-mg, 10-mg, and 20-mg strengths) can be used in place of methylprednisolone
^†If between days 1 to 14 the patient is extubated, the patient is advanced to day 15 of drug therapy and tapered according to schedule
^‡When patients leave the intensive care unit, if they are still not tolerating enteral intake for at least 5 days, they should be given the dosage specified but divided into two doses and given every 12 h IV push until tolerating ingestion of medications by mouth

ISSN: 2052-0492