ABSTRACT
Corticosteroids have been considered as a potential treatment for the acute respiratory distress syndrome (ARDS) since its original description in 1967 (1). However, 35 years hence, definitive evidence to support their use is lacking. In this chapter we will review the published clinical trials of glucocorticoids in ARDS. Because ARDS is commonly present in patients with severe sepsis and septic shock, the clinical trials of corticosteroids in sepsis are relevant to this discussion. We will review the published clinical experience with corticosteroids in patients with persistent fibroproliferative-phase ARDS and the more recent experience addressing an evolving concept of corticosteroid replacement therapy in patients with “relative” adrenal insufficiency. The topic has also recently been reviewed by Luce (2). Our goal is to provide the reader with the background and rationale for continued interest in studying corticosteroids as a clinical intervention in ARDS.
