COVID-19: Major study shows dexamethasone improves mortality among ventilated patients

The use of corticosteroids in systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) isn’t new, so it isn’t surprising that treatment of critically ill COVID-19 patients in the ICU has increasingly involved dexamethasone. Nevertheless, the first major results showing improvement in survival among ventilated COVID-19 patients given dexamethasone comes as very welcome news.

At the clinical level, early responses to this pandemic have often not been informed by a good evidence base as health care workers have struggled to come up with alternatives to what would otherwise be little more than supportive measures. There is no effective antiviral medication with which to combat COVID-19, and beyond basic treatments like proning and ventilation (overuse of which can cause problems of its own), recovery from this disease is up to the patient’s immune system (which can go awry, as in the case of deadly SIRS and MODS).

From the abstract:

“In the dexamethasone group, the incidence of death was lower than that in the usual care group among patients receiving invasive mechanical ventilation (29.3% vs. 41.4%; rate ratio, 0.64; 95% CI, 0.51 to 0.81) and among those receiving oxygen without invasive mechanical ventilation (23.3% vs. 26.2%; rate ratio, 0.82; 95% CI, 0.72 to 0.94) but not among those who were receiving no respiratory support at randomization (17.8% vs. 14.0%; rate ratio, 1.19; 95% CI, 0.91 to 1.55).”

[1] Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report. New England Journal of Medicine. July 2020. doi:10.1056/nejmoa2021436