Acute respiratory distress syndrome (ARDS) has been associated with considerable morbidity and mortality, even before the COVID-19 pandemic hit. For the most part, ARDS management is limited to supportive care and prevention of complications. This means low tidal volumes, moderate to high positive end-expiratory pressure, and prone positioning when necessary. It may also mean corticosteroids (CS). I think. Maybe.
Twenty years ago, when I was a medicine resident interested in critical care, we used the "Meduri protocol" to treat ARDS. This was based on a small randomized controlled trial (RCT) published in JAMA by Umberto Meduri and colleagues in 1998. Patients enrolled had ARDS for at least 7 days without showing signs of improvement. Patients in the treatment arm received large amounts of CS (2 mg/kg/d initially) with a 32-day taper. The authors found a reduction in ICU and hospital-related mortality; the Meduri protocol was endorsed. So for a period of time, I gave CS to patients with ARDS who met the inclusion criteria from this study.
In 2006, a larger RCT, published in The New England Journal of Medicineby the National Heart, Lung, and Blood Institute ARDS Clinical Trials Network (ARDSNet), cast doubt on the Meduri protocol. The researchers found no differences in mortality rates in patients treated with CS vs those who received a placebo.
