Survey of Critical Care Clinicians on Use of Corticosteroids in Acute Respiratory Distress Syndrome

Introduction: Corticosteroids have been studied as a treatment option for acute respiratory distress syndrome (ARDS) with varying results. Until recently, there were no guideline recommendations for the use of steroids in ARDS, but the American Thoracic Society and the Society of Critical Care Medicine (SSCM) both published guidelines in the last two years that include the conditional recommendation for corticosteroids in ARDS. The objective of this study was to evaluate self-reported use of corticosteroids for treatment of ARDS from critical care pharmacists and providers across the United States to evaluate current practice based on recently updated recommendations.


Methods: This study utilized an online survey assessing the use of corticosteroids in the treatment of ARDS. The survey assessed participant demographics, ARDS management, and corticosteroid use in ARDS with and without a concurrent condition that would typically indicate a corticosteroid. The survey was distributed electronically to members of the American College of Clinical Pharmacy, several SCCM state chapters, and healthcare professionals located in Florida and Georgia. Descriptive statistics were utilized for all data.


Results: Sixty-two responses were received, which mostly included pharmacists (73%) and attending physicians (21%). Most respondents reported routine use of corticosteroids in their practice (87%), with dexamethasone used most frequently (91%) often in early, moderate to severe ARDS, but after lung protective ventilation, heavy sedation, prone positioning, and volume management. Responses varied regarding the steroids used in patients with other steroid-indicated conditions with a mix of dexamethasone, hydrocortisone, and methylprednisolone/prednisone depending on the specific concurrent condition. Of the 8 respondents who reported not utilizing corticosteroids for ARDS in their practice, rationale included perceived limited quality data, side effects, and potential harm demonstrated in previous studies.


Conclusions: The majority of critical care clinicians surveyed are utilizing corticosteroids as part of a multi-faceted strategy in treating ARDS. While dexamethasone appears to be the preferred corticosteroid, this may change depending on if concurrent conditions in which corticosteroids are usually indicated are present.