{"id":22680,"date":"2023-02-02T03:17:00","date_gmt":"2023-02-01T19:17:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=22680"},"modified":"2023-02-02T05:49:20","modified_gmt":"2023-02-01T21:49:20","slug":"icu-management-practice-%e5%9c%b0%e5%a1%9e%e7%b1%b3%e6%9d%be%e5%92%8c%e6%b0%a7%e7%96%97%e7%ad%96%e7%95%a5%e6%b2%bb%e7%96%97%e6%96%b0%e5%86%a0%e8%82%ba%e7%82%8e%e5%90%88%e5%b9%b6%e4%bd%8e%e6%b0%a7","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=22680","title":{"rendered":"[ICU Management & Practice]: \u5730\u585e\u7c73\u677e\u548c\u6c27\u7597\u7b56\u7565\u6cbb\u7597\u65b0\u51a0\u80ba\u708e\u5408\u5e76\u4f4e\u6c27\u6027\u547c\u5438\u529f\u80fd\u8870\u7aed"},"content":{"rendered":"\n

Dexamethasone and Oxygen Support Strategies for COVID-19 Hypoxaemic Respiratory Failure<\/h1>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Acute hypoxaemic respiratory failure (AHRF) is one of the main manifestations of severe COVID-19. The RECOVERY trial showed that dexamethasone 6 mg\/d for ten days reduced 28-day mortality in patients with the most severe COVID-19. Another study described the benefit of high-dose dexamethasone in ARDS. However, Munch et al. found no difference between high-dose and low-dose dexamethasone on 28-day mortality. Hence, the matter remains unclear. Similarly, the advantages of high-flow nasal oxygen therapy (HFNo2<\/sub>) and continuous positive airway pressure (CPAP) for managing COVID-19\u2013related AHRF are still debated.<\/p>\n\n\n\n

The COVIDICUS trial investigated the effects of high-dose vs low-dose dexamethasone on 60-day time to all-cause mortality in patients with COVID-19. The study also compared different oxygenation strategies, including high-flow nasal oxygen (HFNo2<\/sub>) or continuous positive airway pressure (CPAP) vs standard oxygen support on 28-day time to fulfilling invasive mechanical ventilation (IMV) criteria in patients with COVID-19 and severe acute hypoxaemic respiratory failure (AHRF). <\/p>\n\n\n\n

Nineteen ICUs in France participated in this trial, which included COVID-19 patients with AHRF. Study patients received standard dexamethasone for ten days or high-dose dexamethasone. Patients who did not require IMV were randomised to standard oxygen support, CPAP, or HFNo2<\/sub>.<\/p>\n\n\n\n

The primary outcome of the study was time to all-cause mortality at day 60 for dexamethasone and time to IMV requirement at day 28 for oxygen support. Five hundred and forty-six patients were included in the study, out of which 414 were randomised between standard dexamethasone or high-dose dexamethasone. Three hundred and thirty-three patients were randomised among standard oxygen therapy, CPAP and HFNo2<\/sub>.  <\/p>\n\n\n\n

The study found no differences in the 60-day mortality based on the dexamethasone dose. Similarly, no significant difference was observed in the 28-day cumulative need for IMV based on oxygenation strategy. Hence, these findings show that in patients with COVID-19 and AHRF, high-dose dexamethasone or different oxygenation strategies had no major impact on mortality or requirement for IMV criteria. <\/p>\n\n\n\n

Source: JAMA<\/a><\/p>\n\n\n\n

Image Credit: iStock <\/p>\n\n\n\n

Continuous Cuff Pressure Control in Preventing Ventilator-Associated Pneumonia \u00bb\u00bb<\/a><\/p>\n\n\n\n

References:<\/h4>\n\n\n\n

Bouadma L, Mekontso-Dessap A, Burdet C et al. (2022) High-Dose Dexamethasone and Oxygen Support Strategies in Intensive Care Unit Patients With Severe COVID-19 Acute Hypoxemic Respiratory Failure: The COVIDICUS Randomized Clinical Trial<\/a>. JAMA Intern Med.<\/em> 182(9):906\u2013916. <\/p>\n\n\n\n

Published on : Tue, 20 Sep 2022<\/p>\n","protected":false},"excerpt":{"rendered":"

Dexamethasone and Oxygen Support Strategies for COVID-1 […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[24,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22680"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=22680"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22680\/revisions"}],"predecessor-version":[{"id":22681,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22680\/revisions\/22681"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=22680"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=22680"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=22680"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}