Trial reportThe Lancet. Respiratory medicine2020
Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial.
Trial report in The Lancet. Respiratory medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 7 registered trials, which are not on this map. Cited by 660 papers, 15 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Efficacy of Dexamethasone Treatment for Patients With ARDS Caused by COVID-19
Efficacy of Higher vs. Lower Doses of Dexamethasone in Patients With Acute Hypoxemic Respiratory Failure (Including ARDS) Caused by Infections (Including COVID-19)
Effect of Dexamethasone in Patients With ARDS and COVID-19 - Prospective, Multi-centre, Open-label, Parallel-group, Randomized Controlled Trial (REMED Trial)
Randomized Open Investigation Determining Steroid Dose (ROIDS-Dose)
Randomized Controlled Trial on the Efficacy of Dexamethasone Versus Methyl Prednisolone in Covid-19 Infected Patients With High Oxygen Flow
Platform Adaptive Embedded Trial for Acute Respiratory Distress Syndrome
Efficacy, Safety, and Tolerability of Methylprednisolone in Critically Ill Patients With the Hyperinflammatory Phenotype: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Phase II Trial
Who cites it
660 citing papers in PubMed, 15 syntheses or guidelines pooled it, 1,206 citations in OpenAlex.
- Efficacy of higher-dose versus lower-dose corticosteroids in community-acquired pneumonia: a systematic review and network meta-analysis.Critical care (London, England) · 2026Pooled it
- Clinical Practice Guideline: Mechanical Ventilation and Extracorporeal Membrane Oxygenation in Acute Respiratory Insufficiency.Deutsches Arzteblatt international · 2026Guideline
- Identifying effect modifiers of corticosteroids in acute respiratory distress syndrome: a meta-regression analysis of randomized controlled trials.BMC pulmonary medicine · 2026Pooled it
- Effect of therapeutic interventions combined with lung-protective ventilation on long-term mortality of patients with acute respiratory distress syndrome: a network meta-analysis.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2026Pooled it
- Efficacy and safety of corticosteroids in critically ill patients: a systematic review and meta-analysis.BMC anesthesiology · 2025Pooled it
- Corticosteroids for treating sepsis in children and adults.The Cochrane database of systematic reviews · 2025Pooled it
- Corticosteroids for adult patients hospitalised with non-viral community-acquired pneumonia: a systematic review and meta-analysis.Intensive care medicine · 2025Pooled it
- Glucocorticoids can reduce mortality in patients with severe community-acquired pneumonia: a systematic review and meta-analysis of randomized controlled trials.European journal of medical research · 2025Pooled it
- Comparative outcomes of corticosteroids, neuromuscular blocking agents, and inhaled nitric oxide in ARDS: a systematic review and network meta-analysis.Frontiers in medicine · 2025Pooled it
- Efficacy of corticosteroids in patients with acute respiratory distress syndrome: a meta-analysis.Annals of medicine · 2024Pooled it
- Impact of different corticosteroids on severe community-acquired pneumonia: a systematic review and meta-analysis.BMJ open respiratory research · 2024Pooled it
- An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome: An Official American Thoracic Society Clinical Practice Guideline.American journal of respiratory and critical care medicine · 2024Guideline
- Sample size estimation in clinical trials using ventilator-free days as the primary outcome: a systematic review.Critical care (London, England) · 2023Pooled it
- Heterogeneity of surrogate outcome measures used in critical care studies: A systematic review.Clinical trials (London, England) · 2023Pooled it
- A systematic review and meta-analysis of glucocorticoids treatment in severe COVID-19: methylprednisolone versus dexamethasone.BMC infectious diseases · 2023Pooled it
- Efficacy and safety of perioperative intravenous dexamethasone in type 2 diabetes mellitus patients undergoing total hip arthroplasty: a prospective randomized controlled trial.Journal of orthopaedic surgery and research · 2026Trial
- Effects of two different dexamethasone dosing regimens on ventilator-free days and long-term mortality in COVID-19 patients with moderate-to-severe ARDS: the REMED randomized clinical trial.European journal of medical research · 2024Trial
- The Effectiveness of Mini-Pulse Methylprednisolone in the Treatment of Patients With COVID-19 in the Intensive Care Unit.Immunity, inflammation and disease · 2024Trial
- Glucocorticoid treatment increases cholesterol availability during critical illness: effect on adrenal and muscle function.Critical care (London, England) · 2024Trial
- Phase I/II clinical trial of efficacy and safety of EGCG oxygen nebulization inhalation in the treatment of COVID-19 pneumonia patients with cancer.BMC cancer · 2024Trial
600 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
22 authors at 14 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThere is no proven specific pharmacological treatment for patients with the acute respiratory distress syndrome (ARDS). The efficacy of corticosteroids in ARDS remains controversial. We aimed to assess the effects of dexamethasone in ARDS, which might change pulmonary and systemic inflammation and result in a decrease in duration of mechanical ventilation and mortality.
methodsWe did a multicentre, randomised controlled trial in a network of 17 intensive care units (ICUs) in teaching hospitals across Spain in patients with established moderate-to-severe ARDS (defined by a ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen of 200 mm Hg or less assessed with a positive end-expiratory pressure of 10 cm H
findingsBetween March 28, 2013, and Dec 31, 2018, we enrolled 277 patients and randomly assigned 139 patients to the dexamethasone group and 138 to the control group. The trial was stopped by the data safety monitoring board due to low enrolment rate after enrolling more than 88% (277/314) of the planned sample size. The mean number of ventilator-free days was higher in the dexamethasone group than in the control group (between-group difference 4·8 days [95% CI 2·57 to 7·03]; p<0·0001). At 60 days, 29 (21%) patients in the dexamethasone group and 50 (36%) patients in the control group had died (between-group difference -15·3% [-25·9 to -4·9]; p=0·0047). The proportion of adverse events did not differ significantly between the dexamethasone group and control group. The most common adverse events were hyperglycaemia in the ICU (105 [76%] patients in the dexamethasone group vs 97 [70%] patients in the control group), new infections in the ICU (eg, pneumonia or sepsis; 33 [24%] vs 35 [25%]), and barotrauma (14 [10%] vs 10 [7%]).
interpretationEarly administration of dexamethasone could reduce duration of mechanical ventilation and overall mortality in patients with established moderate-to-severe ARDS.
fundingFundación Mutua Madrileña, Instituto de Salud Carlos III, The European Regional Development's Funds, Asociación Científica Pulmón y Ventilación Mecánica.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.