Abstract
Rationale: It is unclear whether the timing of dexamethasone initiation is associated with positive outcomes. Objectives: To evaluate the appropriate timing of systemic dexamethasone initiation in critically ill patients with COVID-19. Methods: A multicenter, non-interventional cohort study including adults with COVID-19 patients admitted to intensive care units (ICUs) received systemic dexamethasone between March 2020 and January 2021. Patients were divided into two groups based on the timing for dexamethasone use (early vs. late). Early use is defined as the new initiation of dexamethasone within 24 hours of ICU admission. Propensity score matching was used based on the patient’s SOFA score, MV within 24 hours of ICU admission, proning status, and tocilizumab use during ICU stay. Results: A total of 480 patients were included in the study; dexamethasone was initiated early within 24 hours of ICU admission in 367 patients. Among 202 patients matched using propensity score, 101 had received dexamethasone after 24 hours of ICU admission (1:1 ratio). The 30-day mortality (OR [95%CI]: 1.82[1.04, 3.19], P=0.04) and in-hospital mortality (OR [95%CI]: 1.80[1.03, 3.15], P=0.04). Among the non-mechanically ventilated patients, late use of dexamethasone was associated with higher odds of developing respiratory failure that required MV (OR [95%CI]: 3.8 [1.41, 10.3], P=0.008) Conclusion: Early use of dexamethasone within 24 hours of ICU admission in critically ill patients with COVID-19 was associated with mortality benefits. Moreover, dexamethasone's early use might be considered a proactive measure in non-mechanically ventilated critically ill patients with COVID-19, to prevent further complications.
The AIR-SED Study: A Multicenter Cohort Study of SEDation Practices, Deep Sedation, and Coma Among Mechanically Ventilated AIR Transport Patients
