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Corticosteroids in COVID-19 and non-COVID-19 ARDS: a systematic review and meta-analysis.
Chaudhuri, Dipayan; Sasaki, Kiyoka; Karkar, Aram; Sharif, Sameer; Lewis, Kimberly; Mammen, Manoj J; Alexander, Paul; Ye, Zhikang; Lozano, Luis Enrique Colunga; Munch, Marie Warrer; Perner, Anders; Du, Bin; Mbuagbaw, Lawrence; Alhazzani, Waleed; Pastores, Stephen M; Marshall, John; Lamontagne, François; Annane, Djillali; Meduri, Gianfranco Umberto; Rochwerg, Bram.
  • Chaudhuri D; Department of Medicine, McMaster University, Hamilton, ON, Canada.
  • Sasaki K; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
  • Karkar A; Department of Medicine, McMaster University, Hamilton, ON, Canada.
  • Sharif S; Department of Medicine, McMaster University, Hamilton, ON, Canada.
  • Lewis K; Department of Medicine, McMaster University, Hamilton, ON, Canada.
  • Mammen MJ; Department of Medicine, McMaster University, Hamilton, ON, Canada.
  • Alexander P; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
  • Ye Z; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biological Sciences, State University of New York at Buffalo, Buffalo, NY, USA.
  • Lozano LEC; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
  • Munch MW; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
  • Perner A; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
  • Du B; Dept. of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
  • Mbuagbaw L; Dept. of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
  • Alhazzani W; Medical ICU, Peking Union Medical College Hospital, Beijing, China.
  • Pastores SM; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
  • Marshall J; Biostatistics Unit, The Research Institute, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
  • Lamontagne F; Department of Medicine, McMaster University, Hamilton, ON, Canada.
  • Annane D; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
  • Meduri GU; Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
  • Rochwerg B; Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada.
Intensive Care Med ; 47(5): 521-537, 2021 05.
Article in English | MEDLINE | ID: covidwho-1193132
ABSTRACT

PURPOSE:

Corticosteroids are now recommended for patients with severe COVID-19 including those with COVID-related ARDS. This has generated renewed interest regarding whether corticosteroids should be used in non-COVID ARDS as well. The objective of this study was to summarize all RCTs examining the use of corticosteroids in ARDS.

METHODS:

The protocol of this study was pre-registered on PROSPERO (CRD42020200659). We searched online databases including MEDLINE, EMBASE, CDC library of COVID research, CINAHL, and COCHRANE. We included RCTs that compared the effect of corticosteroids to placebo or usual care in adult patients with ARDS, including patients with COVID-19. Three reviewers abstracted data independently and in duplicate using a pre-specified standardized form. We assessed individual study risk of bias using the revised Cochrane ROB-2 tool and rated certainty in outcomes using GRADE methodology. We pooled data using a random effects model. The main outcome for this review was 28-day-mortality.

RESULTS:

We included 18 RCTs enrolling 2826 patients. The use of corticosteroids probably reduced mortality in patients with ARDS of any etiology (2740 patients in 16 trials, RR 0.82, 95% CI 0.72-0.95, ARR 8.0%, 95% CI 2.2-12.5%, moderate certainty). Patients who received a longer course of corticosteroids (over 7 days) had higher rates of survival compared to a shorter course.

CONCLUSION:

The use of corticosteroids probably reduces mortality in patients with ARDS. This effect was consistent between patients with COVID-19 and non-COVID-19 ARDS, corticosteroid types, and dosage.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / COVID-19 Type of study: Etiology study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Adult / Humans Language: English Journal: Intensive Care Med Year: 2021 Document Type: Article Affiliation country: S00134-021-06394-2

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / COVID-19 Type of study: Etiology study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Adult / Humans Language: English Journal: Intensive Care Med Year: 2021 Document Type: Article Affiliation country: S00134-021-06394-2