Glucocorticoid treatment in acute lung injury and acute respiratory distress syndrome

Crit Care Clin. 2011 Jul;27(3):589-607. doi: 10.1016/j.ccc.2011.05.007.


Experimental and clinical evidence show a strong association between dysregulated systemic inflammation and progression of acute respiratory distress syndrome (ARDS). This article reviews eight controlled studies evaluating corticosteroid treatment initiated before day 14 of ARDS. Available data provide a consistent strong level of evidence for improving outcomes. Treatment was also associated with a markedly reduced risk of death. This low-cost highly effective therapy is well-known, and has a low-risk profile when secondary prevention measures are implemented. The authors recommend prolonged methylprednisolone at 1 mg/kg/d initially in early ARDS, increasing to 2 mg/kg/d after 7 to 9 days of no improvement.

Publication types

  • Review

MeSH terms

  • Acute Lung Injury / complications
  • Acute Lung Injury / drug therapy*
  • Animals
  • Anti-Inflammatory Agents / adverse effects
  • Anti-Inflammatory Agents / therapeutic use*
  • Glucocorticoids / adverse effects
  • Glucocorticoids / therapeutic use*
  • Humans
  • Inflammation / complications
  • Inflammation / drug therapy*
  • Pneumonia / drug therapy*
  • Randomized Controlled Trials as Topic
  • Respiratory Distress Syndrome / complications
  • Respiratory Distress Syndrome / drug therapy*


  • Anti-Inflammatory Agents
  • Glucocorticoids