1. Study findings suggest that early administration of intravenous dexamethasone during acute respiratory distress syndrome may decrease duration of mechanical ventilation and mortality rates.
Evidence Level: 1 (Excellent)
Acute respiratory distress syndrome (ARDS), characterized by acute hypoxemic respiratory failure and bilateral pulmonary infiltrates, is associated with significant mortality rates and currently have no proven pharmacological therapies. Although a previous meta-analysis provided evidence for the potential application of corticosteroids as a treatment option, there has been insufficient evidence to suggest a mortality benefit. In this multicenter, randomized controlled trial, 277 patients with established moderate-to-severe ARDS in a network of 17 intensive care units (ICUs) in Spain were enrolled and assigned to either serve as controls or receive intravenous (IV) dexamethasone during their hospital stay. The primary outcome measure was the number of ventilator-free days at 28 days (defined as days alive and free from mechanical ventilation from day of randomization to day 28), and the secondary outcome measure was all-cause mortality 60 days after randomization. The treatment group, which received 20mg of IV dexamethasone once daily from day 1 to day 5 and 10mg IV dexamethasone once daily day 6 to day 10, was observed to have significantly greater ventilator-free days versus controls (between-group difference 4.8 days [95% CI 2.57 to 7.03]; p<0.0001). All-cause mortality at 60 days was also significantly lower in the treatment group compared to control, with 21% in the former and 36% in the latter (between group difference -15.3% [95% CI -25.9 to -4.9]; p<0.005). This is the first randomized trial testing the efficacy of dexamethasone in patients with ARDS, and suggests that early therapy with dexamethasone could potentially modify the host immune response leading to greater ventilator free days and pose a mortality benefit. With further investigation, dexamethasone may present itself as one of the first pharmacologic therapies for the treatment of ARDS.
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