Muhammad Ahmad
Pulmonary Critical Care Fellow
University at Buffalo
Buffalo, NY
Disclosure information not submitted.
Rajesh Kunadharaju, MBBS
Fellow
University at Buffalo
Buffalo, New York, United States
Disclosure information not submitted.
Sri Harika Meka, MD
Resident
University at Buffalo, United States
Disclosure information not submitted.
Gregory Fuhrer, MD
Attending
University at Buffalo, New York, United States
Disclosure information not submitted.
Title: High Dose Dexamethasone in Patients with SARS- CoV- 2 infection requiring Oxygen in Medical ICU.
Introduction: SARS-CoV-2(COVID-19) is a novel corona virus with wide range of clinical manifestations. Beneficial effects of Dexamethasone in hospitalized patients with COVID-19 related lung injury were confirmed by RECOVERY Trial (Dexamethasone 6mg /day). Pre-COVID data regarding corticosteroids for the treatment of Acute Respiratory Distress Syndrome (ARDS) with high dose (20mg) Dexamethasone is suggestive of improved survival (Villar et al, LANCET, 2020 Feb 7). Several patients with COVID-19 infection admitted to ICU at Buffalo General Hospital received high dose dexamethasone prior to RECOVERY Trial. Our objective was to determine whether use of high-dose dexamethasone in these patients resulted in improved outcomes.
Methods: Patients with COVID- 19 infection admitted to ICU requiring oxygen supplementation were included from March 2020 to May 2020 until RECOVERY trial results were published. The two patient groups received either Dexamethasone 20mg/day for 5 days then 10mg/day for 5 days( or until ICU stay) plus standard care vs standard care alone. We analyzed 28 days all-cause mortality, need for mechanical ventilation (MV), MV days, time to intubation, trends in inflammatory markers, oxygenation parameters, need for renal replacement therapy, secondary infection, and venous thromboembolism (VTE ) at 28 days.
Results: A total of 78 patient charts were included and reviewed for the study. The intervention group had 30 patients (mean age 60.67, 56.7% male) and control group had 48 patients (63.54, 66.7% male). Both groups had similar demographics and comorbidities. Need for MV was significantly less in Intervention group compared to control group (p= 0.03). Intervention groups also showed trend towards increased time to intubation (mean 4.5 days SD± 4.67 vs. 2.74 days SD± 2.85); however not statistically significant (p=0.20). Other outcomes; 28-day all-cause mortality (p= 0.64), MV days (p= 0.78), need of dialysis (p= 0.49), secondary infection (p= 0.47), and venous thromboembolism (p= 1.0) were not statistically different.
Conclusions: High dose Dexamethasone in patients with COVID 19 infection requiring oxygen shows decreased need for mechanical ventilation if treated early. Dexamethasone use was not associated with increased risk of secondary infection, renal failure or VTE.