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Corticosteroids in ARDS Evidence — FRCA Final MCQ

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HardIntensive Care MedicineCorticosteroids in ARDS EvidenceFRCA Final

A 68-year-old woman (ASA III) is in the ICU with community-acquired pneumonia. She develops ARDS. The ICU team commences her on IV hydrocortisone for refractory shock. Which recent trial provides the strongest evidence for corticosteroids in ARDS?

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Correct answer: D — DEXA-ARDS trial (dexamethasone in moderate-severe ARDS)

The DEXA-ARDS trial (Villar et al, 2020) demonstrated that early dexamethasone 20 mg/day for 5 days then 10 mg/day for 5 days in moderate-severe ARDS (PaO2/FiO2 ≤200 within 24 hours of meeting ARDS criteria) significantly reduced mechanical ventilation duration and 60-day mortality (21% vs 36%). This provides the strongest disease-specific evidence for corticosteroids in ARDS. The RECOVERY trial was specific to COVID-19. Current ICS guidelines recommend considering dexamethasone in moderate-severe ARDS.

Reference: Villar J et al – 2020 – DEXA-ARDS trial; ICS – 2024 – ARDS guidelines