Effectiveness and Outcome of Methylprednisolone versus Hydrocortisone in Treatment of Acute Respiratory Distress Syndrome (ARDS)

Abstract

Introduction: Acute respiratory distress syndrome (ARDS) is the clinical manifestation of severe acute lung injury. It is characterized by dyspnea, profound hypoxemia, diffuse bilateral infiltrates secondary to non-cardiogenic pulmonary edema on chest radiography, and decreased lung compliance. It occurs most frequently in the setting of sepsis, aspiration of gastric contents, trauma, or multiple blood transfusions. ARDS places a significant burden on the healthcare system, with an estimated prevalence of 7% of ICU admissions and hospital mortality rate of 50%.Pulmonary and systemic inflammations are the pathophysiologic hallmarks of this syndrome, and activation of the glucocorticoid receptor in pulmonary and circulating cells is an essential step in restoring homeostasis. Provision of supplemental oxygen, lung rest, and supportive care are the fundamentals of therapy. Acute respiratory distress syndrome frequently requires endotracheal intubation and mechanical ventilation. A low tidal volume and low plateau pressure ventilator strategy is recommended to avoid ventilator-induced injury. The use of low-dose corticosteroids was associated with improved mortality and morbidity outcomes without increased adverse reactions. The aim of this study is to compare the effectiveness of methylprednisolone to hydrocortisone in improvement of PaO2/FiO2 ratio, reduction of inflammatory marker, reduce duration of mechanical ventilation, reduce duration of intensive care unit stay and decrease of mortality rate in critical ill patients with ARDS