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World J Crit Care Med. Jun 9, 2024; 13(2): 91225
Published online Jun 9, 2024. doi: 10.5492/wjccm.v13.i2.91225
Steroids in acute respiratory distress syndrome: A panacea or still a puzzle?
Sharmili Sinha, Rohit Patnaik, Srikant Behera
Sharmili Sinha, Department of Critical Care Medicine, Apollo Hospitals, Bhubaneswar 751005, Odisha, India
Rohit Patnaik, Department of Critical Care Medicine, Medeor 24x7 Hospital, Al Danah 40330, Abu Dhabi, United Arab Emirates
Srikant Behera, Department of Internal Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar 751019, Odisha, India
Author contributions: Sinha S conceived the idea; Sinha S, Patnaik R and Behera S performed literature search; Sinha S and Patnaik R wrote the paper; All authors reviewed the language before submission.
Conflict-of-interest statement: All authors have no conflicts of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sharmili Sinha, MD, Adjunct Associate Professor, Department of Critical Care Medicine, Apollo Hospitals, Bhubaneswar 751005, Odisha, India. sromsinha1011@gmail.com
Received: December 25, 2023
Revised: April 28, 2024
Accepted: May 15, 2024
Published online: June 9, 2024
Processing time: 161 Days and 2 Hours
Abstract

Acute respiratory distress syndrome (ARDS) is a unique entity marked by various etiologies and heterogenous pathophysiologies. There remain concerns regarding the efficacy of particular medications for each severity level apart from respiratory support. Among several pharmacotherapies which have been examined in the treatment of ARDS, corticosteroids, in particular, have demonstrated potential for improving the resolution of ARDS. Nevertheless, it is imperative to consider the potential adverse effects of hyperglycemia, susceptibility to hospital-acquired infections, and the development of intensive care unit acquired weakness when administering corticosteroids. Thus far, a multitude of trials spanning several decades have investigated the role of corticosteroids in ARDS. Further stringent trials are necessary to identify particular subgroups before implementing corticosteroids more widely in the treatment of ARDS. This review article provides a concise overview of the most recent evidence regarding the role and impact of corticosteroids in the management of ARDS.

Keywords: Acute respiratory distress syndrome; Corticosteroids; Septic shock; Community acquired pneumonia; COVID-19; Randomized controlled trials

Core Tip: Acute respiratory distress syndrome (ARDS) was described in 1967. For decades, various pharmacotherapies, including corticosteroids, have been examined for treatment, with corticosteroids showing potential for improving outcomes. However, corticosteroids have potential adverse effects including hospital-acquired infections and intensive care unit acquired weakness. The authors have analysed and reviewed the existing evidence regarding the role of corticosteroids in the management of community acquired pneumonia with respiratory failure, coronavirus disease 2019 pneumonia, septic shock and ARDS.