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Corticosteroid May Harm Respiratory Distress Patients

Administration more than two weeks after acute respiratory distress syndrome onset may increase mortality risk

WEDNESDAY, April 19 (HealthDay News) -- Methylprednisolone is no better than placebo at improving mortality rates in patients with persistent acute respiratory distress syndrome (ARDS) and may increase the risk of death if started more than two weeks after the onset of ARDS, according to a study published April 20 in the New England Journal of Medicine.

Kenneth P. Steinberg, M.D., of the University of Washington in Seattle, and colleagues randomly assigned 180 patients with ARDS of at least seven days' duration to receive either methylprednisolone or placebo.

The researchers found the 60-day hospital mortality rate was 28.6 percent in the placebo group and 29.2 percent in the methylprednisolone group and that the 180-day rates were 31.9 percent and 31.5 percent, respectively. Among patients enrolled at least 14 days after the onset of ARDS, methylprednisolone was associated with significantly increased 60- and 180-day mortality rates.

"In conclusion, routine administration of corticosteroids in ARDS cannot be recommended today, and their use seems harmful when started two weeks or more after onset," states the author of an accompanying editorial. "Clinical research must continue in this area to enhance our understanding of basic mechanisms of lung injury, physiologic defense mechanisms and tissue repair."

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