Table 1 Characteristics of included studies
Study name (first author and year) | Study design | Study groups and patients’ number | Inclusion criteria | Treatment regimen | Duration of treatment | Follow-up duration |
|---|---|---|---|---|---|---|
Bernard 1987 | Multicenter randomized controlled trial | Total patients, 99 Steroids, 50 Placebo, 49 | Adult patients having ARDS withPaO2 ≤ 7 0mmhg (with FiO2 at least 40%) or PaO2/PAO2 ≤ 0.3; bilateral diffuse infiltrates on chest radiography, PAWP ≤ 18mmhg regardless of PEEP level. | -Treatment started after ARDS onset. Methylprednisolone 30 mg every 6 h (4 doses only). | 24 h | Until death or for 45 days |
Meduri 1998 | Multicenter randomized controlled trial | Total Patients, 24 Steroids, 16 Placebo, 8 | Adult patients with hypoxemic respiratory failure diagnosed with ARDS, who were on mechanical ventilation for at least 7 days, with LIS of 2.5 or greater and less than 1-point reduction from day 1 of ARDS onset. | -Treatment started after 7 days of ARDS onset. -Methylprednisolone 2 mg/kg per day (2 mg/kg from day 1 to day 14; 1 mg/kg from day 15 to 21; 0.5 mg/kg from day 22 to day 28; 0.25 mg/day from day 28 to day 32). | 32 days | Hospital length of stay. |
Confalonieri 2005 | Multicenter randomized controlled trial | Total patients, 46 Steroids, 22 Placebo, 23 | Patients with clinical and radiographic evidence of pneumonia with bilateral or multi-lobar involvement and PaO2/FiO2 ratio less than 250. | -Treatment started after diagnosis. -Hydrocortisone 200 mg bolus followed by an infusion of 10 mg/h. | 7 days | 60 days |
Annane 2006 | Multicenter randomized controlled trial | Total patients, 177 Steroids, 85 Placebo, 92 | Patients with septic shock and ARDS; bilateral infiltrates on chest radiography; PaO2/FiO2 ≤ 200, PAWP ≤ 18 mmhg; no left atrial hypertension. | -Treatment started after randomization which occurred within 8 h of disease onset. -Hydrocortisone 50 mg every 6 h and 9 alpha fludrocortisone 50 milligram orally once a day. | 7 days | 28 days |
Steinberg 2006 | Multicenter randomized control trial | Total patients, 180 Steroids, 89 Placebo, 91 | Adult patients who had ARDS and mechanically ventilated for 7 to 28 days. PaO2/FiO2 ≤ 200 mmhg. | -Treatment started after 7 to 28 days of ARDS onset. -Methylprednisolone: bolus 2 mg/kg followed by 0.5 mg/kg every 6 h for 14 days and then 0.5 mg/kg every 12 hours for 7 days and then tapering over 4days. | 21-25 days. | 60 days |
Meduri 2007 | Multicenter randomized control trial | Total patients, 91 Steroids, 63 Placebo, 28 | Adult intubated patients with early ARDS (≤ 72 h) defined by the American-European Consensus definition. | -Treatment started within 72 h of ARDS onset. -Methylprednisolone bolus dose of 1 mg/kg followed by an infusion of 1 mg/kg per day from day 1 to day 14; 0.5 mg/kg per day from day 15 to day 21; 0.25 mg/kg per day from day 22 to day 25; and 0.125 mg/kg per day from day 26 to day 28. | Up to 28 days | Hospital length of stay. |
Tongyoo 2016 | Single-center randomized controlled trial | Total patients, 197 Steroids, 98 Placebo, 99 | Adult patients with severe sepsis or septic shock, intubated with ARDS (according to criteria of ARDS by the American European Consensus or by the berlin criteria as moderate to severe ARDS) | -Randomization within 12 h of ARDS onset. -Hydrocortisone 50 mg every 6 h for 7 days | 7 days | 28 days |
Villar 2020 | Multicenter randomized control trial | Total patients, 277 Steroids, 139 Placebo, 138 | Adult intubated patients with acute onset of ARDS according to criteria of ARDS by the American European Consensus or by the berlin criteria as moderate to severe ARDS. | Dexamethasone 20 mg daily from day 1 to day 5, then 10 mg daily from day 6 to day 10. | 10 days | 60 days |