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Coronavirus: Study Shows Dexamethasone Reduces Patient Ventilator Days

Analysis  |  By Christopher Cheney  
   September 14, 2020

Reduction in the number of days seriously ill coronavirus patients are on mechanical ventilation can reduce respiratory complications.

Dexamethasone treatment for coronavirus disease 2019 (COVID-19) patients with moderate or severe acute respiratory distress syndrome (ARDS) reduces the number of days patients spend on mechanical ventilation, a recent research article shows.

Earlier research has found that as many as 12% of hospitalized COVID-19 patients require invasive mechanical ventilation, with most of those patients developing ARDS. Mechanical ventilation is associated with several respiratory complications such as barotrauma, ventilator-associated lung injury, and ventilator-associated pneumonia.

The recent research, which was published by JAMA Network Open, gathered data from 41 ICUs in Brazil. There were nearly 300 COVID-19 patients in the study, with 151 randomly assigned to receive intravenous dexamethasone and standard care, and 148 in a control group that only received standard care. For the treatment group, patients received 20 mg of dexamethasone intravenously daily for five days, then 10 mg of dexamethasone daily for five days or until ICU discharge.

The study generated several key data points:

  • Patients in the dexamethasone group had a mean of 6.6 ventilator-free days during their first 28 days of hospitalization, compared to a mean of 4.0 ventilator-free days in the standard care group.
     
  • Sequential Organ Failure Assessment (SOFA) mean scores, which range from 0 to 24 with higher scores indicating greater organ dysfunction, were lower in the dexamethasone group (6.1) than in the standard care group (7.5) at seven days.
     
  • There was no significant difference between the two groups in all-cause mortality at 28 days, ICU-free days during the first 28 days of hospitalization, or a six-point ordinal scale measuring clinical status.

"Among patients with COVID-19 and moderate or severe ARDS, use of intravenous dexamethasone plus standard care compared with standard care alone resulted in a statistically significant increase in the number of ventilator-free days (days alive and free of mechanical ventilation) over 28 days," the recent research article's co-authors wrote.

The decrease in ventilator days for seriously ill COVID-19 patients is a significant benefit for patients and healthcare providers, they wrote. "This reduction is relevant in the context of a pandemic, in which an inexpensive, safe, and widely available intervention like dexamethasone increases even modestly the number of ventilator-free days and may reduce the risk of ventilatory complications, ICU length of stay, and burden to the healthcare system."

Remdesivir is the only other drug that has been shown to generate improved clinical outcomes in seriously ill COVID-19 patients.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

Most seriously ill coronavirus patients who require invasive mechanical ventilation develop severe acute respiratory distress syndrome.

The longer patients are on mechanical ventilation, the higher the risk of respiratory complications such as ventilator-associated pneumonia.

In a recent study, intravenous dexamethasone combined with standard care reduced the patient time on mechanical ventilation by 2.6 days compared to patients who only received standard care.


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