Methylprednisolone infusion in early severe ARDS: results of a randomized controlled trial. 

Meduri, G Umberto. Golden, Emmel. Freire, Amado X. Taylor, Edwin. Zaman, Muhammad. Carson, Stephanie J. Gibson, Mary. Umberger, Reba. Chest. 131(4):954-63, 2007 Apr.

• Severe early ARDS (≤ 72 h)

• A loading dose of 1 mg/kg.

• Methylprednisolone was mixed in 240mL of normal saline solution and administered daily as an infusion at 10 mL/h and changed to a single oral dose when enteral intake was restored

• methylprednisolone infusion 1 mg/kg/d from day 1 to day 14,

• 0.5 mg/kg/d from day 15 to day 21

• 0.25 mg/kg/d from day 22 to day 25

• 0.125 mg/kg/d from day 26 to day 28. 

• If the patient was extubated between days 1 and 14, the patient was advanced today 15 of drug therapy and tapered according to schedule.

• If the patient failed to improve  LIS  (***see definition below) between days 7 and 9,  iniciar ttratamiento con (2 mg/kg/d) for unresolving ARDS (ver abajo)

• Experts Indicate Methylprednisolone May Save One in Six Treated Patients (Approximately 35,000 patients in the U.S. a Year

***For patients remaining intubated on study day 7, improvement in lung function was defined as follows: (1) a reduction in LIS ≥1 point, and (2) a day 7 LIS ≤ 2.0 (for study entry LIS ≤ 2.9) or ≤ 2.5 (for study entry LIS 3.0)

Tratamiento con metilprednisolona en el SDRA no resuelto

Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome: a randomized controlled trial. JAMA 1998;280:159-65.

• A loading dose of 2 mg/kg
• 2 mg/kg per day from day 1 to day 14 (0.5 mg/kg   IV push every 6 h)
• 1 mg/kg per day from day 15 to day 21 (0.25 mg/kg IV push every 6 h)
• 0.5 mg/kg per day from day 22 to day 28 (0.125 mg/kg IV push every 6 h)
• 0.25 mg/kg per day on days 29 and 30  (single  dose)
• 0.125 mg/kg per day on days 31 and 32. (single  dose)
• If the patient was extubated prior to day 14, treatment was advanced to day 15 of drug therapy and tapered according to schedule

In this study, prolonged administration of methylprednisolone in patients with unresolving ARDS was associated with improvement in lung injury and MODS scores and reduced mortality