{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:38:15Z","timestamp":1787841495513,"version":"build-2784847793"},"reference-count":100,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Semin Respir Crit Care Med"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Acute respiratory distress syndrome (ARDS) remains a heterogeneous and a major challenge disease process despite five decades of study. Emerging translational data delineate three overlapping phases: exudative, proliferative, and fibroproliferative, each driven by distinct immune\u2013mechanical pathways and potentially modifiable by glucocorticosteroids (GC) modulation. Contemporary clinical randomized trials and meta-analyses indicate that early (\u226472\u2009hours) administration of systemic GCs at receptor-saturating doses (e.g., dexamethasone from 20 to 10\u2009mg\/day, or methylprednisolone 1\u20132\u2009mg\/kg\/day) accelerates resolution of pulmonary edema, shortens mechanical ventilation duration, and improves intensive care survival, while prolonged tapering regimens are required once fibroproliferation is established. Conversely, delayed initiation (&gt;14 days), viral pneumonitis with high viral load, recent surgical anastomosis, or uncontrolled fungal coinfection constitute \u201cred flags\u201d in which GCs might increase mortality. Latent-class analyses\u2014a statistical modeling approach in which multivariable data are reduced to indirectly observed (latent) variables\u2014identified two (hyper- and hypoinflammatory) ARDS phenotypes that likely might respond differentially to GC exposure, although we lack validation studies. Therefore, it seems that biomarker-guided precision therapy is poised to replace the historical one-size-fits-all approach. This narrative review integrates epidemiology, pathobiology, pharmacology, and clinical evidence to provide a phase-specific, phenotype-directed framework for GC use in ARDS and outlines future research priorities aimed at harmonizing molecular endotyping with dose, timing, and tapering strategies.<\/jats:p>","DOI":"10.1055\/a-2721-6094","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T23:51:52Z","timestamp":1762905112000},"page":"098-110","source":"Crossref","is-referenced-by-count":4,"title":["Corticosteroids for Acute Respiratory Distress Syndrome"],"prefix":"10.1055","volume":"47","author":[{"given":"Riccardo","family":"Guglielmi","sequence":"additional","affiliation":[{"name":"Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Campanella","sequence":"additional","affiliation":[{"name":"Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jes\u00fas","family":"Villar","sequence":"additional","affiliation":[{"name":"Biomedical Research Networking Center in Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain"},{"name":"Department of Medicine, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada"},{"name":"Multidisciplinary Research Group in Intensive Care (GREMCI), Research Unit, Hospital Universitario Dr. Negr\u00edn, Fundaci\u00f3n Canaria Instituto de Investigaci\u00f3n Sanitaria de Canarias (FIISC), Las Palmas de Gran Canaria, Spain"},{"name":"Faculty of Health Sciences, Universidad del Atl\u00e1ntico Medio, Tafira Baja, Las Palmas de Gran Canaria, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoni","family":"Torres","sequence":"additional","affiliation":[{"name":"Biomedical Research Networking Center in Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain"},{"name":"Department of Anesthesiology and Critical Care Medicine, Fundaci\u00f3 de Recerca Cl\u00ednic Barcelona \u2013 Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer (FRCB-IDIBAPS), University of Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Ferrando","sequence":"additional","affiliation":[{"name":"Biomedical Research Networking Center in Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain"},{"name":"Department of Anesthesiology and Critical Care Medicine, Fundaci\u00f3 de Recerca Cl\u00ednic Barcelona \u2013 Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer (FRCB-IDIBAPS), University of Barcelona, Barcelona, Spain"},{"name":"Department of Anesthesia and Critical Care, Hospital Cl\u00ednic, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,11,11]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/S0140-6736(67)90168-7","article-title":"Acute respiratory distress in adults","volume":"2","author":"D G Ashbaugh","year":"1967","journal-title":"Lancet"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1097\/CCM.0000000000003624","article-title":"A prognostic enrichment strategy for selection of patients with acute respiratory distress syndrome in clinical trials","volume":"47","author":"J Villar","year":"2019","journal-title":"Crit Care Med"},{"issue":"07","key":"ref3","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1001\/jama.2017.21907","article-title":"Acute respiratory distress syndrome: advances in diagnosis and treatment","volume":"319","author":"E Fan","year":"2018","journal-title":"JAMA"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.amjms.2020.12.019","article-title":"Management of ARDS - 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