Glucocorticoids in adults with Acute Respiratory Distress Syndrome: Arandomised, parallel-group, allocation-concealed, open label, pragmatic,group sequential design, clinical and cost- effectiveness trial withinternal pilot: GuARDS Trial

A single drug, dexamethasone, could determine whether a patient with acute respiratory distress syndrome lives or dies — but doctors do not yet know when to give it for the best chance of survival. Acute respiratory distress syndrome (ARDS) is a catastrophic lung injury that floods the air sacs with fluid, starving the body of oxygen. It kills roughly 40 percent of those it strikes. Dexamethasone, a cheap and widely available steroid, dampens the dangerous inflammation that drives ARDS. But the critical question is timing: does giving the drug within 72 hours of diagnosis improve outcomes, or is it too late by then? No large trial has settled this. This trial directly compares early dexamethasone against standard care in adults with ARDS, measuring both clinical effectiveness and cost to the NHS. If early treatment proves superior, the finding would immediately change how intensive care units manage one of the most lethal conditions in critical care. The drug is already on hospital shelves — the change would be in protocol, not procurement. If it does not work, the NHS avoids wasting resources on an ineffective routine. Either way, the answer saves lives or money, and often both.