ARDS: 4 more ventilator-free days, higher survival with high-dose dexamethasone

  • Lancet Resp Med

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • In this trial of patients with acute respiratory distress syndrome (ARDS), early intravenous dexamethasone led to improved outcomes vs routine treatment.
  • Editorial :
    • Criticizes design; notes treatment standards evolved over recruitment period.
    • Concludes “results are not adequate to change clinical practice to support routine use of dexamethasone in this setting.”

Why this matters

  • Studies of corticosteroids for ARDS have been inconclusive; guidelines conflict.

Key results

  • Dexamethasone vs control groups:
    • Ventilator-free days: mean 12.3 (standard deviation [SD], 9.9) days vs 7.5 (SD, 9.0) days (P<.0001>
    • 60-day all-cause mortality: 21% (n=29) vs 36% (n=50; P=.0047).
    • Higher reintubation rate.
    • Shorter duration of mechanical ventilation, lower Quick Sepsis-related Organ Failure Assessment score.
  • Similar between-group rate of adverse events.

Study design

  • Multicenter open-label DEXA-ARDS trial in 17 Spanish ICUs (n=277).
  • Participants were receiving mechanical ventilation for moderate-to-severe ARDS.
  • They were randomly assigned to intravenous dexamethasone for 10 days vs routine care.
  • Dosing: 20 mg daily for first 5 days, 10 mg daily thereafter.
  • Outcome: ventilator-free days at 28 days.
  • Funding: Fundación Mutua Madrileña; Instituto de Salud Carlos III; European Regional Development Fund; Asociación Científica Pulmón y Ventilación Mecánica.

Limitations

  • Narrow inclusion criteria, including exclusion of already steroid-treated patients.
  • Open label.
  • At 88% planned enrollment, trial halted because of low enrollment pace.