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miércoles, 12 de febrero de 2020

Steroid for ARDS?

PulmCrit (EMCrit)
PulmCrit - February 12, 2020 - By Josh Farkas 
"Summary The Bullet:
  • There is considerable overlap between ARDS, severe pneumonia, and intubated patients with septic shock. Studies regarding these conditions may be best understood in the greater context of all three conditions (otherwise we are continually re-designing the wheel).
  • Prior evidence shows that steroid reduces duration of ventilation in ARDS and in intubated septic patients. Likewise, steroid may decrease ICU length of stay and the likelihood of requiring intubation in severe pneumonia. Some studies suggest mortality benefit, whereas others don’t.
  • DEXA-ARDS is a new, multi-center RCT investigating dexamethasone for patients with ARDS (77% of whom had pneumonia or sepsis as the cause of ARDS). Dexamethasone both accelerated liberation from ventilation and reduced mortality.
  • This study provides further support for the use of steroid in patients with both ARDS and either pneumonia or sepsis. It remains unclear whether steroid could benefit other subsets of ARDS patients (e.g. ARDS following trauma).
  • Since dexamethasone is a pure glucocorticoid (with no mineralocorticoid activity), it could act as a cleaner anti-inflammatory agent than most steroids. Its ability to auto-taper is also convenient."