“Acute respiratory distress syndrome (ARDS) is an intense inflammatory process of the lungs in response to acute pulmonary and systemic insults. There are no proven effective, specific pharmacological therapies for ARDS based on the results of randomised clinical trials. Despite no conclusive results, it remains clinically and biologically plausible that corticosteroids might benefit patients with ARDS in the early phase of their disease process, a situation that has not been evaluated in most randomised controlled trials. Paradoxically,
these hormones are given to patients with septic shock and pneumonia, both causes of ARDS.”

“These findings support the hypothesis that early therapy with dexamethasone could
change the systemic immune responses and thereby could reduce the duration of mechanical ventilation and overall mortality.”

“Our findings suggest that the mechanism by which dexamethasone reduces the duration of mechanical ventilation could benefit survival. The mechanisms of action of dexamethasone are similar to other exogenous corticosteroids. In ARDS, down-regulation of pulmonary
and systemic inflammation is essential to restoring homeostasis. Prolonged glucocorticoid therapy has been associated with substantial improvement in indices of alveolar–capillary membrane permeability and mediators of inflammation and tissue repair.”

Villar J, et al Dexamethasone in ARDS network. Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial. Lancet Respir Med. 2020 Mar;8(3):267-276 Full Text for Emory Users