Emerging treatments
Early corticosteroid administration
Controversy regarding the utility of corticosteroids in non-COVID ARDS persists, as clinical trials have mostly been small, heterogeneous, and some were done prior to the era of low tidal volume ventilation.[140] An open-label randomised controlled study of patients with moderate-to-severe ARDS found that early dexamethasone resulted in a substantial increase in ventilator-free days (4.8 days), and a 15% reduction in mortality, compared with placebo.[141] These findings need to be validated and must be considered cautiously given serious concerns about the safety of glucocorticoids in critically ill patients who do not have COVID-19. Additionally, the optimal corticosteroid regimen remains unknown; further research is needed to determine the appropriate formulation, dose, timing, and course of therapy to better guide clinical care. Longitudinal data are also needed to better understand the adverse consequences of corticosteroids.[69] Several large randomised clinical trials of glucocorticoids in ARDS are ongoing and should provide additional evidence to guide use of corticosteroids in ARDS.
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