Low dose corticosteroid for a longer duration at an early phase: A potentially optimal dosage regimen for the management of ARDS

Problem consideredDisparities exist within both clinical practice and literature regarding the use of corticosteroids in management of acute respiratory distress syndrome (ARDS). Given the absence of definitive evidence from a singular research approach, we adopted a mixed method approach design to address this clinical question.MethodsWe employed a sequential exploratory mixed methods approach. Initially, we conducted a retrospective analysis, which was complemented by a comprehensive literature review to identify the best treatment approaches in literature and practice. Subsequently, a semi-structured qualitative interview was conducted to gain insights into perception and experience of the physicians involved in ARDS management. Finally, a meta-inference was applied to synthesize the evidence to propose a corticosteroid regimen for ARDS, considering the patient etiology, dosage, duration, and timing of administration.ResultsThe retrospective evidence (nearly thousand patient data from five years) indicates that, low dose corticosteroid for a longer duration of treatment observed to have a significantly better recovery rate than other strategies. The literature (overview of meta-analyses, clinical guidelines and RCTs), and qualitative (among 9 physicians) evidence strengthened this by supporting the use of low dose corticosteroid (1–2 mg/kg) at the early phase (24–72 h), for a longer duration (minimum 10 days) to have better clinical outcome without safety concerns. Additionally, this provides more insights on ARDS epidemiology, management, efficacy, cost and safety.ConclusionLow-dose corticosteroids for a longer duration of treatment administered at an early phase can be considered a potentially optimal corticosteroid regimen for ARDS which needs to be clinically validated in future.