Steroid treatment for persistent ARDS a word of caution 英文参考文献.docVIP

Available online /content/11/6/425 Letter Steroid treatment for persistent ARDS: a word of caution B Taylor Thompson1, Marek Ancukiewicz1, Leonard D Hudson2, Kenneth P Steinberg2 and Gordon R Bernard3 1Massachusetts General Hospital, Boston, USA 2University of Washington, Seattle, USA 3Vanderbilt University, Nashville, USA Corresponding author: B Taylor Thompson, tthompson1@ Published: 12 December 2007 Critical Care 2007, 11:425 (doi:10.1186/cc6186) This article is online at /content/11/6/425 ? 2007 BioMed Central Ltd See related comments by Meduri et al., /content/11/4/310/comments and related journal club critique by Wajanaponsan et al., /content/11/4/310 Dr Meduri and colleagues, in their comment “Steroid treatment in ARDS: a highly effective treatment” [1], written in response to the article of Wajanaponsan et al. [2], described data and an adjusted analysis provided by the Acute Respiratory Distress Syndrome (ARDS) Network (as a personal communication). We wish to comment on their assertion of large imbalances between the treatment and steroid arms in the cohort of participants randomized after 13 days of ARDS and suggest a word of caution for interpreting this post hoc analysis. The adjusted analysis we provided for Dr Meduri of mortality in the subgroup of 48 patients enrolled after 13 days of ARDS was based on a set of variables derived from our prior trials and reported by us as significant for prediction of mortality in ARDS/acute lung injury (baseline APACHE III, age, plateau pressure, baseline number of organ failures, and baseline alveolar to arterial oxygen difference [A-aDO2]) [5]. With this adjustment, no statistical difference in mortality was seen between treatment arms for patients randomized after 14 days (11.2% for placebo versus 28.0% for MPS, p = 0.57, adjusted, compa