Thread by @CHESTCritCare

1/12 Hey #medtwitter, let’s look at what we know thus far about use of steroids in #COVID19 ARDS.

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@accpchest

2/12 Let’s start with current use of steroids in pre-COVID-19 ARDS, what is the data to support our practices?

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#CHESTPulm
#CHESTInf
@accp

3/12 A recent meta-analysis evaluating prolonged methylprednisolone therapy for ARDS showed a reduction in mortality, with an increase in ventilator-free days.

pubmed.ncbi.nlm.nih.gov/30155260/

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4/12 Do we have any recommendations?

The Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) recommends methylprednisolone 1 mg/kg/day in moderate to severe ARDS (P/F <200).

ncbi.nlm.nih.gov/m/pubmed/28938…

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5/12 Lastly, in the 2020 DEXA-ARDS trial, a RCT of 277 ARDS patients (P/F <200), dexamethasone did accelerate weaning from ventilation, and also reduced mortality.

pubmed.ncbi.nlm.nih.gov/32043986/

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6/12 In the initial phases of the #COVID19 pandemic, we turned to the evidence of steroids in SARS-CoV-1 (a.k.a “SARS”), as both are caused by coronaviruses. What evidence was available for steroids in SARS before any COVID-19 and steroid studies were available?

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7/12 A retrospective study of over 5000 SARS patients concluded that glucocorticoids were beneficial in severe SARS. Average daily dose 0-80 mg/day methylprednisolone equivalent had a hazard ratio for mortality of 0.47(95% CI, 0.24-0.56).

ijcem.com/files/ijcem002…

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8/12 A retrospective study of 152 critically ill SARS patients found that steroid use correlated with reduced mortality and shorter length of stay (when adjusted).

pubmed.ncbi.nlm.nih.gov/16778260/

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9/12 This was the evidence we had going into the #COVID19 pandemic. Now let’s look at #COVID19 emerging evidence.

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10/12 A retrospective study of 201 patients in Wuhan, China, 42% developed ARDS, of whom about half died. In the ARDS subgroup, steroid use correlated with reduced mortality (HR, 0.38; 95% CI, 0.20-0.72).

jamanetwork.com/journals/jamai…

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11/12 Which brings us to now, the recent press release of the RECOVERY trial. RCT of 6,425 #COVID19 patients. Reportedly, dexamethasone reduced deaths by 1/3 in ventilated patients and 1/5 if receiving oxygen only.

recoverytrial.net/files/recovery…

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12/12 The peer-reviewed paper is being anxiously awaited, this press release has prompted more discussions and conversations regarding treatment of COVID-19. What are your thoughts #medtwitter?

#CHESTCritCare
@accpchest