SCCM Resource Library-Corticosteroids in ARDS: Why, When, Which Drug, What Cost?

Video Transcription

Video Summary

In this presentation, Mitchell Buckley, a clinical pharmacy specialist, discusses the controversial topic of corticosteroid use in acute respiratory distress syndrome (ARDS). He focuses on the optimal timing, agent selection, and potential risks associated with corticosteroid use. <br /><br />Buckley starts by providing an overview of different corticosteroid agents commonly used in ARDS, such as hydrocortisone, methylprednisolone, and dexamethasone. He discusses their relative glucocorticoid activity and mineralocorticoid activity, as well as their duration of action.<br /><br />He then reviews the clinical data on corticosteroids' impact on ARDS outcomes. A meta-analysis suggests that corticosteroids may have a beneficial effect on mortality, mechanical ventilator-free days, and the pulmonary function ratio. Another study specifically focused on COVID-19 patients found that dexamethasone, in particular, reduced the risk of death.<br /><br />Regarding the optimal timing of corticosteroid use, Buckley explains that there is no strong evidence to support a specific time frame. Early initiation within 72 hours of ARDS onset may be beneficial, but there is no clear distinction between early and late initiation. The controversial Lazarus trial suggested that initiating steroids after 14 days may be associated with a higher mortality rate, but further analysis suggests that this result may be due to imbalances in baseline characteristics.<br /><br />Buckley also discusses the potential risks of corticosteroid use in ARDS. Hyperglycemia is a common side effect, but there is no evidence of increased risks of serious adverse events such as GI bleeding, new infections, or neuromuscular weakness.<br /><br />In conclusion, Buckley recommends considering early dexamethasone use in ARDS. Although the optimal timing, agent selection, and potential risks of corticosteroid use are still controversial, the available evidence suggests that corticosteroids, especially dexamethasone, may have a beneficial impact on ARDS outcomes. The potential benefits of improved survival and ventilator-free days outweigh the risks of hyperglycemia. However, there is still much unknown about corticosteroid use in ARDS, and further research is needed to provide more definitive recommendations.

Asset Subtitle

Pharmacology, Pulmonary, 2022

Asset Caption

Corticosteroids are commonly used and frequently debated in critical illness settings. This session will review our basic understanding of the range of corticosteroid effects pertinent to critical illness and will summarize evidence for the utility of corticosteroids for two common ICU syndromes: acute respiratory distress syndrome and sepsis.

Meta Tag

Content Type Presentation

Knowledge Area Pharmacology

Knowledge Area Pulmonary

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Pharmacokinetics Pharmacodynamics

Tag Acute Respiratory Distress Syndrome ARDS

Year 2022

Keywords

corticosteroid use

acute respiratory distress syndrome

optimal timing

agent selection

potential risks

glucocorticoid activity

mineralocorticoid activity

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