ARDS · Corticosteroids in ARDS
Dexamethasone treatment for the acute respiratory distress syndrome
| Design | Multicentre, randomised controlled trial, stopped early for low enrolment |
|---|---|
| Treatment | Dexamethasone for up to 10 days |
| Control | Routine intensive care |
| Population | 277 patients with established moderate-to-severe ARDS |
| Follow-up | 60 days |
| Primary endpoint | Ventilator-free days at 28 days |
| Result | Mean ventilator-free days were higher with dexamethasone, a between-group difference of 4.8 days (95% CI 2.57 to 7.03, p<0.0001). Sixty-day mortality was also lower with dexamethasone. The trial was stopped after enrolling 88% of its planned sample because of a low enrolment rate. |
| Secondary endpoints | 60-day all-cause mortality, ICU length of stay, adverse events |
Early administration of dexamethasone could reduce duration of mechanical ventilation and overall mortality in patients with established moderate-to-severe ARDS.
The trial authors, in the published abstract
Positive, but slow-recruiting, unblinded, and stopped before completion — a combination that argues for caution. It landed just before the pandemic made dexamethasone in hypoxaemic respiratory failure routine for other reasons, so its independent contribution has never been cleanly retested.
Villar J, Ferrando C, Martínez D, et al. Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial. Lancet Respir Med 2020 Mar;8(3):267-276.