Use Of Glucocorticoids In Acute Respiratory Distress Syndrome: A Systematic Review

Objective:To systematically review the therapeutic effects and safety of different doses of glucocorticoids(GC) for different periods of acute respiratory distress syndrome(ARDS).Methods :Data bases such as PubMed、Medline、EBSCO、Elsevier、CNKI、CBM、weipu、wanfang were electronically searched.All literature about GC for ARDS were included. According to the inclusion and exclusion criteria, extracted data, and evaluated the methodological quality of the included studies. Then meta-analysis was performed using RevMan 5.2 software. For continuous outcomes, we compare outcome measures using the means difference(MD) with 95 % confidence intervals(CI).For dichotomous outcomes,the odds ratio(OR)was used.After heterogeneity test, date without heterogeneity could be using fixed effect model.Those with heterogeneity could be using randomized effect model estimated.Results :A total of 9 studies involving 692 cases(GC group 366,control groups 326) were included. The result of meta-analysis showed that: Between the steroid group and the control group, there were significant differences(P<0.05)in mortality in patients treated during early stage with low doses of glucocorticoids,the relative risk(RR)and 95% confidence interval(CI) is 0.75(0.62,0.92); there was no significant difference(P>0.05)in mortality in patients treated with high doses; Between the GC group and the control group, there was no significant difference(P>0.05)in mortality in patients treated during late stage with large doses of glucocorticoids;There were significant differences( P < 0.05) in proving PaO2/FiO2 and ventilator-free days in patients treated with low doses of glucocorticoids, while no significant difference(P>0.05) in increasing in new infections.Conclusions:1. During the early ARDS patients(7 days), using the small dose of glucocorticoid can improve the mortality of patients with ARDS, and large dose or late(7 days) using hormones does not reduce mortality;2. Small dose of glucocorticoid can improve oxygenation, prolong offline;High-dose corticosteroids can improve oxygenation in a short time, but it is impossible to extend the time of patients with offline;3. In terms of safety, this study shows that the use of corticosteroids for the treatment of patients with ARDS did not increase the risk of new infections.