Acute Respiratory Distress Syndrome (ARDS) is an acute diffuse, inflammatory lung injury, leading to capillary leak and loss of aerated lung tissue. Multiple different treatment modalities have been investigated for the treatment of ARDS without improvement in mortality. Until recently, lung-protective ventilation and prone positioning are the only two interventions with a mortality benefit, and there have been no pharmacological therapies with significant patient centered benefits.

Corticosteroids have been recommended for the treatment of ARDS by the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM) based on a meta-analysis of nine randomized controlled trials demonstrating a reduction in the markers of inflammation and duration of mechanical ventilation, although many of the trials had a small sample size and some were performed without lung protective ventilation

In March 2020, the Lancet published the DEXA-ARDS multicenter randomized controlled trial performed by Villar et al. investigating the impact of dexamethasone on survival and mechanical ventilation duration in patients with moderate to severe ARDS (PaO2/FiO2 < 200). 

DEXA-ARDS is the largest randomized control trial of corticosteroid therapy for moderate to severe ARDS. It is a well-performed trial showing that dexamethasone increased ventilator-free days by greater than four days and survival by 15 percent in moderate to severe ARDS. 

This trial provides strong evidence that corticosteroids should be initiated early in ARDS treatment for patients without contraindications.