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Corticosteroids therapy in pediatric acute respiratory distress syndrome
Maria Clara de Magalhães Barbosa1, Arnaldo Prata Barbosa2, Patricia Rieken Macêdo Rocco3
1Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brasil.
Insights
Corticosteroids may improve outcomes for pediatric acute lung injury/acute respiratory distress syndrome by reducing inflammation. Early, prolonged methylprednisolone is suggested, but more pediatric research is needed to confirm safety and efficacy.
Area of Science:
- Pediatric critical care medicine
- Pulmonology
- Pharmacology
Background:
- Corticosteroid use in pediatric acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is controversial and understudied.
- Existing research primarily focuses on adult ALI/ARDS populations.
Purpose of the Study:
- To review experimental and clinical evidence on corticosteroid therapy for pediatric ALI/ARDS.
- To evaluate the risks and benefits of corticosteroid use in children with ALI/ARDS.
Main Methods:
- Extensive literature review (1980-2010) of experimental and clinical studies, reviews, and meta-analyses.
- Searched multiple databases (Medline, Cochrane, SciELO, Lilacs, Bireme) using keywords: ALI, ARDS, steroids, child, clinical trials, meta-analyses, reviews, case reports.
Main Results:
- Corticosteroids down-regulate systemic inflammatory response, improving oxygenation.
- Benefits include reduced multiple organ dysfunction, shorter mechanical ventilation, and decreased ICU stay.
- Early, prolonged methylprednisolone (1 mg/kg/day infusion) is suggested with infection surveillance.
Conclusions:
- Methylprednisolone may be beneficial for pediatric ALI/ARDS, suggesting early and prolonged administration.
- Recommendations include adjusting diagnostic parameters and endpoints for pediatric trials.
- Further research is essential to establish safety, efficacy, and optimal monitoring for pediatric patients.
Abstract:
The use of corticosteroids in acute lung injury and acute respiratory distress syndrome is one of the most controversial issues in the literature. However, acute lung injury/acute respiratory distress syndrome studies are restricted to adults, despite the widespread use of corticosteroid for hyper-reactive respiratory airway diseases in children. This review aimed to describe experimental and clinical evidence for corticosteroid therapy in acute lung injury/acute respiratory distress syndrome and to point out the risks and benefits of its use in pediatrics. For this purpose, an extensive review of the literature was performed from 1980 to 2010 including both experimental and clinical papers, as well as reviews and meta-analysis, using Medline, Cochrane Central Register of Controlled Trials, Cochrane database of systematic reviews, SciELO, Lilacs and Bireme databases. The search terms were: acute lung injury, acute respiratory distress syndrome, steroids, child, clinical trials, meta-analyses, reviews, and case reports. Most studies showed that the corticosteroids-induced down-regulation of systemic inflammatory response is associated with oxygenation improvement, reduction of multiple organ dysfunctions, mechanical ventilation time, and intensive care units length of stay. Based on the literature, the authors suggest early and prolonged methylprednisolone administration for acute lung injury/acute respiratory distress syndrome, using continuous 1 mg/kg/day infusion to prevent glycemic variability, associated with strict infection surveillance. In addition, they recommend some diagnostic parameters, interventions and choices of endpoint variables to be adjusted to improve pediatric trials feasibility. Therefore, more research is required to establish the safety and efficacy of methylprednisolone in pediatric patients with acute lung injury/acute respiratory distress syndrome , as well as to determine the best parameters for monitoring steroid side effects and outcomes.
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