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