This large retrospective study investigated whether starting high-dose (2 mg/kg) methylprednisolone therapy after 14 days of Acute Respiratory Distress Syndrome (ARDS) onset increased the risk of complications or mortality compared to starting it earlier.

Study Summary and Key Findings

Objective: To compare the outcomes (six-month mortality, ventilator-free days, ICU-free days, and complications) between early (< day 14) and late (≥ day 14) initiation of 2 mg/kg methylprednisolone therapy in ARDS patients. Study Population: 392 ARDS patients were included in the retrospective analysis.

Mortality Result: The key finding was that there was no significant difference in six-month mortality between the early initiation group (51.9%) and the late initiation group (52.2%, p = 0.942). This neutrality was maintained even when analyzing non-COVID-19 ARDS patients and non-ECMO patients separately.

Ventilation and ICU Time: Both ventilator-free days (VFDs) and ICU-free days 60 days after starting the protocol were similar between the early and late groups.

Complications: While a high percentage of patients (89.8%) experienced at least one complication (VAP, new septic shock, or GI bleeding) after starting the protocol, the occurrence of these complications was associated with the timing of initiation relative to the 14-day mark, as expected.

Delaying the initiation of 2 mg/kg methylprednisolone until after day 14 of ARDS onset did not increase six-month mortality or negatively affect VFDs/ICU-free days. The authors suggest that delayed initiation can be a viable option for patients with persistent ARDS who haven’t improved on earlier or lower steroid doses.

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