Development of an Optimal Corticosteroid Dosage Regimen for the Management of Acute Respiratory Distress Syndrome: A Sequential Explanatory Mixed Method Approach

OBJECTIVES: Conflicts exists regarding the use of corticosteroid in acute respiratory distress syndrome (ARDS) with respect to etiology, dose, duration and time of administration, along with difference in perception of treating physicians and available literature evidence. This study aimed to develop an optimal corticosteroid treatment regimen for ARDS by drawing an inference from mixed method findings.

METHODS: This study followed a sequential exploratory mixed method approach. Initially, a retrospective analysis was performed to understand the prescription pattern of corticosteroids in the clinical setting and to develop a treatment regimen which was supported by the literature review. Qualitative research was conducted in the later phase to understand the perception and experience of treating physicians on the use of corticosteroids in ARDS. Finally, a meta-inference was drawn from these evidence to develop an optimal corticosteroid treatment regimen for ARDS focused on patient etiology, dose, duration, time of administration along with the clinical outcomes.

RESULTS: The retrospective evidence indicates that, the low dose corticosteroid for a longer duration of treatment observed to have a significantly better recovery rate than other strategies. The literature evidence supports the use of low dose corticosteroid (1-2 mg/kg) at the early phase (24-72 hours), for a longer duration (minimum 7 days) to have a better clinical outcome. The qualitative research from the physicians also indicated the use of low dose steroid for a longer duration in the early phase is comparatively effective and safer.

CONCLUSIONS: This mixed method research recommends the use of low dose (1-2 mg/kg of methyl prednisolone or equivalent dose) for 3-5 days, tapering 50% of dose over 10 days administered within 24-72 hours of hospital admission or ARDS diagnosis for a longer duration (a total of >15 days) as an optimal corticosteroid regimen for ARDS.