Anna White, PharmD,
PGY-2 CC Pharmacy Resident
Denver Health
Denver, CO
Disclosure information not submitted.
Rebecca Swayngim, PharmD, BCCCP,
Critical Care Pharmacist
Denver Health Medical Center
Denver, CO
Disclosure information not submitted.
Andy Kim, BCCCP, PharmD, BCCCP
Clinical Pharmacy Specialist, MICU
Denver Health
Denver
Disclosure information not submitted.
Title: Impact of Dexamethasone Dose on Days of Mechanical Ventilation in Patients with COVID-19 and ARDS
Introduction:
Dexamethasone is associated with an increased number of ventilator-free days and reduced mortality in patients with acute respiratory distress syndrome (ARDS). Among hospitalized patients with COVID-19 pneumonia, dexamethasone has demonstrated a survival benefit. Dosing strategies vary between the two indications with no evidence for a standardized approach in patients with COVID-19 associated ARDS. The purpose of this study is to investigate the impact of dexamethasone dose on days of mechanical ventilation in patients with COVID-19 and moderate to severe ARDS.
Methods:
This retrospective chart review included patients with COVID-19 and moderate to severe ARDS (PaO2/FiO2 [P/F] ≤ 200) who received at least 10 days of dexamethasone within 14 days of hospital admission. Patients were grouped into two cohorts: those who received an average daily dexamethasone dose ≤ 6 mg versus > 6 mg. The primary study endpoint was mechanical ventilation days between groups. Secondary endpoints included in-hospital mortality rate, intensive care unit (ICU) length of stay, and P/F ratio on day 14 of hospitalization.
Results:
Sixty-one patients met inclusion criteria with 11 patients (18%) receiving a median of 10 mg (interquartile range [IQR] 8-13) of dexamethasone per day and 50 patients (82%) receiving a median of 6 mg (IQR 6-6) per day. Patients in the high-dose cohort received a median of 12 days of dexamethasone while patients in the low-dose cohort received a median of 10 days of treatment (p< 0.01). There was no significant difference in median days of mechanical ventilation between groups (16 vs 17 days, p=0.95). In-hospital mortality rate (55% vs 42%, p=0.45), median ICU length of stay (17 vs 12 days, p=0.46), and median P/F ratio on day 14 (110 vs 110, p=0.82) were comparable between groups.
Conclusions:
Patients who received dexamethasone doses over 6 mg had significantly longer treatment courses than patients who received 6 mg or less, without an associated reduction in duration of mechanical ventilation. This study is limited by a small sample size and observational design. Larger prospective trials are warranted to determine optimal steroid dosing in moderate to severe ARDS secondary to COVID-19 pneumonia.