Use of corticosteroids in the adult respiratory distress syndrome: A clinical review

Adult respiratory distress syndrome (ARDS) is a major cause of morbidity and mortality in critically ill patients. This form of acute respiratory failure represents a stereotypic response of the lung to many injurious mediators. Adult respiratory distress syndrome is characterized by pulmonary infiltrates, severe hypoxemia, and reduced lung compliance, and expresses clinically as an increased-permeability pulmonary edema. Despite modern treatment modalities, the high mortality rate (>50%) from ARDS has not appreciably decreased over the last 20 years. A major issue of controversy in the therapy of ARDS is the use of corticosteroids (CS) for the prophylaxis and treatment of this syndrome. In this report, current concepts of the pathophysiology of ARDS are discussed, while focusing on potential areas of benefit of CS. Experience with steroids is then reviewed, considering human studies of CS in established ARDS and pulmonary fibrosis, and the prevention of ARDS in high risk patients. After considering available data, it is concluded that the use of CS cannot be recommended for the prevention or therapy of ARDS.