Dexamethasone treatment for the acute respiratory distress syndrome

Recently published a trial about this topic Here, it seem that dexamethasone could reduce duration of mechanical ventilation, but I have some concern about it.

The author refers a meta-analysis of nine randomised controlled trials in patients with ARDS, but all the trials are before the standardized use of protective mechanical ventilation, so how we can assure that the clinical benefit is because the used of dexamethasone in stead of the protective mechanical ventilation?

In this trial for ventilatory management, physicians followed recommendations for lung-protective mechanical ventilation in both treatment groups.

If there a possibility that, what’s the really end point of the trial is compare the differences in protective lung ventilation without us realizing?


were rates of administering “lung protective” mechanical ventilation different between the groups? they don’t seem to say in the paper. And it is not part of the outcome? ie lung protective mechanical ventilation (according to protocol) preempts mechanical ventilation (outcome)? maybe i’m confused…

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