In general, a rule for corticosteroids in preventing or relieving the acute respiratory distress syndrome (ARDS) has yet to be established, although these drugs are indicated for conditions such as Pneumocystis carinii pneumonia. High-dose corticosteroids have not been shown to reduce mortality through their anti-inflammatory properties when given early to patients with sepsis, septic shock, or ARDS. Corticosteroids have been shown, however, to reduce mortality in patients with late ARDS only in one small, inconclusive study. More recent investigators have focused on the usefulness of low-dose corticosteroids in reducing mortality in patients with sepsis or septic shock who may have relative adrenal insufficiency, but these studies also are inconclusive, and it is unclear that low-dose corticosteroids affect the development of ARDS in these patients.
Department of Medicine and Anesthesia, University of California, San Francisco and the Medical-Surgical Intensive Care Unit San Francisco General Hospital, San Francisco, California USA
Address reprint requests to: John M. Luce, MD San Francisco General Hospital 1001 Potrero Avenue, Room 5K1 San Francisco, CA 94110
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