Take home points For steroids in ARDS
1. Steroids use has to be early ( with in 72 hours of onset / admission ) , methyl prednisolone is the most used . Meduri et al protocol has been the most used . Dose has to low and prolonged
2. Dexamethasone has been studied in adult population. It has been found efficacious. It was chosen as it has less mineralocorticoid effect ( less fluid accumulation ) along with an auto tapering effect plus a cheap drug ( Dexa ARDS Trial , Lancet 2020)
3. In children with ARDS and septic shock , choice may move to hydrocortisone versus methyl prednisolone . It has to be given as infusion
4. No studies for comparison available on dexa versus methylprednidolone versus hydrocortisone
5. No clear evidence for use in trauma/ drowning related ARDS
6. For Chemical pneumonitis ( all our poisoning ) early use of steroids plus surfactant may be helpful
7. Clear no for steroids in children with fungal pneumonia, influenza related ARDS
8. Biomarkers guides therapy ( IL-6, il-8, interferon gamma, surfactant proteins may be the future wherever feasible . BAL fluid is more useful
9. Multiple trials in adult have used dexamethasone based on CRP/Procalcitonin in patient with at risk and mild ARDS . It has been found useful to halt progression of disease.
10. Indian cohort is more of infections and tropical illness leading to ARDS . We need more homogenous group of cohort for further trials on steroids and ARDS
11. Steroids doesn’t increase the risk of hospital acquired infections compared to no steroids group .
12. Choose your patient wisely . Start the steroids early. Need studies for use in children for using dexamethasone.
FIAP critical care ( PGIMER, Chandigarh )
DM Pediatric critical car