University Medical Center, Groningen, the Netherlands
Correspondence to: Jack J. Ligtenberg, MD, University Medical Center, PO Box 30001, Groningen, 9700 RB, the Netherlands; e-mail: firstname.lastname@example.org
We admire the endurance of Dr. Meduri et al1in completing their ARDS study (April 2007). However, during the 10 years that passed after the start of this study there have been important changes in daily ICU practice. In the control arm, with 46% catecholamine-dependent patients, no steroids were administered in the first week. With the spread of the Surviving Sepsis Campaign,2most patients in the control arm and probably several in the treatment arm would nowadays have received low-dose steroids (100 to 300 mg/24 h). We wonder how much of the beneficial results of the study are attributable to undertreatment of the control patients. Surprisingly Dr. Annane, one of the advocates of low-dose steroid treatment in septic shock, did not mention this item in the accompanying editorial.3 We can image the enthusiasm for steroids, but the study by Meduri et al1 does not justify the unconditional title of the editorial. Even Dr. Meduri advises a further study with stratification to minimize the risks of mismatching as occurred in this study.
The authors have no conflicts of interest to disclose.
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