Low dose corticosteroid for a longer duration at an early phase: A potentially optimal dosage regimen for the management of ARDS

<h2>ABSTRACT</h2><h3>Problem considered</h3> Disparities exist within both clinical practice and literature regarding the use of corticosteroids in management of acute respiratory distress syndrome (ARDS). Given the absence of definitive evidence from a singular research approach, we adopted a mixed method approach design to address this clinical question. <h3>Methods</h3> We employed a sequential exploratory mixed methods approach. Initially, we conducted a retrospective analysis, which was complemented by a comprehensive literature review to identify the best treatment approaches in literature and practice. Subsequently, a semi-structured qualitative interview was conducted to gain insights into perception and experience of the physicians involved in ARDS management. Finally, a meta-inference was applied to synthesize the evidence to propose a corticosteroid regimen for ARDS, considering the patient etiology, dosage, duration, and timing of administration. <h3>Results</h3> The retrospective evidence (nearly thousand patient data from five years) indicates that, low dose corticosteroid for a longer duration of treatment observed to have a significantly better recovery rate than other strategies. The literature (overview of meta-analyses, clinical guidelines and RCTs), and qualitative (among 9 physicians) evidence strengthened this by supporting the use of low dose corticosteroid (1-2 mg/kg) at the early phase (24-72 hours), for a longer duration (minimum 10 days) to have better clinical outcome without safety concerns. Additionally, this provides more insights on ARDS epidemiology, management, efficacy, cost and safety. <h3>Conclusion</h3> Low-dose corticosteroids for a longer duration of treatment administered at an early phase can be considered a potentially optimal corticosteroid regimen for ARDS which needs to be clinically validated in future.