Acute Respiratory Distress Syndrome and Steroids: An Unresolved Puzzle

Abstract

BACKGROUND Acute respiratory distress syndrome (ARDS) is a life-threatening condition characterized by widespread lung inflammation, leading to the accumulation of fluid in the alveoli. According to the Berlin criteria, ARDS is defined by acute onset (within one week of a known insult), bilateral radiographic infiltrates not fully explained by cardiac failure, and a PaO₂/FiO₂ ratio of ≤300 mm Hg.

OBJECTIVE This review aims to summarize the pathophysiology, diagnostic criteria, imaging findings, and current therapeutic controversies—particularly the role of glucocorticoids—in the management of ARDS.

DISCUSSION The hallmark of ARDS is the breakdown of alveolar-capillary membrane integrity, leading to protein-rich edema that impairs gas exchange. Patients typically develop severe hypoxemia and dyspnea within 6–72 hours of an inciting event. Imaging plays a crucial role: chest X-ray shows bilateral opacities, while CT often reveals diffuse or dependent consolidations and ground-glass opacities, particularly in the posterior lung zones. Despite advances in supportive care, specific pharmacological interventions remain debated. The use of glucocorticoids, for instance, is contentious due to inconsistent evidence regarding their impact on mortality and the risk of secondary infections.

CONCLUSION ARDS is a complex syndrome of acute inflammatory lung injury with multiple potential triggers and a well-defined diagnostic framework. Although imaging and clinical criteria aid in diagnosis, treatment continues to rely largely on supportive lung-protective ventilation. The role of anti-inflammatory therapies such as glucocorticoids is not yet clearly defined and warrants further rigorous investigation. Improved understanding of the molecular pathways involved may lead to more targeted and effective interventions in the future.